Improving healthcare equity through tele-health: a spatial accessibility-based optimization approach †

The increasing demand for chronic disease medical resources due to rapid aging and urbanization in China and the uneven distribution of healthcare facilities make accessibility and equity critically important in public services. To respond to such challenges, tele-health has been viewed as an effective way to improve access to healthcare and promote equity, especially for elderly chronic-disease patients. This work develops an improved two-step floating catchment area method to incorporate tele-health for chronic diseases (i2SFCA-THC) for elderly chronic-disease patients in a hybrid healthcare system involving offline community care, referral-based tertiary care, and online care, where tele-health is incorporated into the accessibility analysis in a quantitative manner. Based on this framework, an equity-constrained resource allocation model is further formulated to examine how the allocation of online chronic disease medical resources affects both overall regional accessibility and interregional equity in the context of hospital digital transformation. In addition, analytical properties and sensitivity analysis are used to explore the relationships among key parameters and derive managerial insights. Finally, a case study is conducted to illustrate the applicability of the proposed framework.