Organizational Determinants of Telemedicine Equity Outcomes in Latin American Public Health Systems

This study examines how organizational factors shaped telemedicine equity outcomes across 623 public hospitals in Chile, Mexico, Colombia, Ecuador, and Uruguay from 2015 to 2025. Using hospital-year data from ministry databases, PAHO registries, waiting-time records, audit reports, training logs, and technology-readiness assessments, the analysis combines descriptive statistics, multilevel regression, difference-in-differences estimation, country-level models, and a limited instrumental-variable sensitivity analysis. Results show that the rural–urban specialist waiting-time gap declined from 5.1 to 1.9 days after telemedicine expansion. Centralized implementation was associated with a 0.187-unit improvement in the Access Equity Index, while each additional 10 hours of staff training was associated with a 0.024-unit improvement. Findings suggest that telemedicine equity depends not only on technology adoption, but also on organizational coordination, workforce preparation, and implementation capacity within public health systems.