Analyzing national telemedicine policies in China from the perspective of policy instrument (1997–2020)

In recent years, the Chinese government has frequently issued policies to promote the rapid development of telemedicine with the aim of improving the primary medical service capacity and public medical conditions in remote areas of China.A three-dimensional analytical framework was built to analyze the rationality of existing national telemedicine policies, providing valuable insights for the future construction and formulation of telemedicine policy. In total, 271 telemedicine policy documents with 537 policy clauses in relation to telemedicine were identified, and they are subjected to a rigorous analysis from the perspectives of policy instrument, telemedicine development stage, and telemedicine development element.China's telemedicine policies have grown rapidly since 1997 and gradually moved towards exploratory stage (9/551, 1.68%), normative stage (93/551, 17.62%), mature stage (239/551, 44.51%), and rapid growth stage (196/551, 36.50%). Meanwhile, the types of telemedicine policy instruments adopted include mandatory tools (360/551, 61.71%), voluntary tools (82/551, 14.88%), information tools (74/551, 13.43%), and economic tools (55/551, 9.98%). The majority of telemedicine policies were related to platform construction, accounting for 45.07% (242/537), while telemedicine policies relating to service operation (20.67%, 111/537), service application (20.86%, 112/537), and organizational management (13.41%, 72/537) were comparatively less.China's policy instruments have developed from simplification to diversification, from relative imbalance to equilibrium, and the balance between the vertical and horizontal objectives of the policy have also strengthened. However, some policy tools are improperly applied at the policy stage, and there is still room for improvement in the allocation of policy elements.