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Unequal spatial patterns and differentiated city roles in the intercity telemedicine system

Nature Cities (2026) Cite this article

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Abstract

Telemedicine is a key instrument for addressing healthcare disparities, yet the intercity telemedicine system (ITS) remains underexplored. Here, leveraging large-scale consultation data from online healthcare platforms, we reveal the spatial structure and city roles within China’s ITS. First, the ITS shows the structure of a highly interconnected network, enhancing systemic efficiency but also generating new inequalities by concentrating resources in major hubs and limiting patient choices in cities with fewer medical resources. Second, the ITS partly deviates from the traditional hierarchy where patients primarily seek care in the nearest major administrative center; instead, it moves toward connections driven by specific medical expertise and patient needs, while still partially reflecting the logic of face-to-face healthcare. Third, city roles within the ITS are structurally differentiated, characterized by patterns where a few dominant hubs centralize most activity while many others remain on the margins, alongside the rise of cities that leverage digital platforms to attract medical demand from diverse regions outside their own provinces, despite having relatively limited physical healthcare resources. This reflects the dual mechanism of online healthcare platforms: concentrating flows toward top-tier hubs—marginalizing smaller cities in supply roles—while enhancing service accessibility in low-resource cities and expanding the outreach of ordinary cities.

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Fig. 1: The degree distribution of the ITCN.
The alternative text for this image may have been generated using AI.
Fig. 2: Triadic structures and topological patterns in the ITCN.
The alternative text for this image may have been generated using AI.
Fig. 3: Results of ITCN–CPP consistency analysis.
The alternative text for this image may have been generated using AI.
Fig. 4: Spatial distribution of SSC, IHC and CHD across cities.
The alternative text for this image may have been generated using AI.
Fig. 5: City roles in the ITS.
The alternative text for this image may have been generated using AI.

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Data availability

The processed network datasets are available via figshare at https://doi.org/10.6084/m9.figshare.31872136 (ref. 47). The raw telemedicine consultation records were obtained from the HaoDF platform (https://www.haodf.com/) and are not publicly available due to legal and privacy restrictions. Other datasets used in this study were collected from public sources: Top 100 Hospitals data from the Hospital Management Institute at Fudan University (https://www.fdygs.com/); socioeconomic indicators (GDP, broadband users, industry employment, telecommunications volume and mobile users) from the China Statistical Yearbook (https://www.stats.gov.cn/); and the China Digital Inclusive Finance Index from the Digital Finance Research Center of Peking University (https://www.idf.pku.edu.cn/zsbz/bjdxszphjrzs/index.htm). Hospital grade classifications were also obtained from the HaoDF platform.

Code availability

The analysis was conducted using Python. The code used to support the findings of this study is available via figshare at https://doi.org/10.6084/m9.figshare.31872136 (ref. 47).

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Acknowledgements

We acknowledge the financial support for this research provided by the Humanities and Social Sciences Fund of Ministry of Education of China (grant no. 24YJA630097, W.W.), which contributed to the conceptualization, design, data collection, preparation of the paper and decision to publish, and National Natural Science Foundation of China (grant no. 42471304, W.W.), which contributed to the conceptualization and design.

Author information

Authors and Affiliations

  1. School of Urban Design, Wuhan University, Wuhan, China

    Bowen Xiang, Mengyao Hong, Fang Guo & Wei Wei

  2. China Institute of Development Strategy and Planning, Wuhan University, Wuhan, China

    Wei Wei

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  1. Bowen Xiang
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  2. Mengyao Hong
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  3. Fang Guo
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  4. Wei Wei
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Contributions

B.X. contributed to conceptualization, methodology, software, validation, formal analysis, investigation, data curation, writing—original draft, writing—review and editing, and visualization. M.H. contributed to methodology, software, investigation, writing—review and editing, and visualization. F.G. contributed to validation, investigation and visualization. W.W. contributed to conceptualization, resources, supervision, project administration and funding acquisition.

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Correspondence to Wei Wei.

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Nature Cities thanks Chenyu Fang, Mengzhu Zhang, Yuerong Zhang and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Supplementary Information (download PDF )

Supplementary Figs. 1–14, Tables 1–9 and Notes 1–9.

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Supplementary Software 1 (download ZIP )

Replication package containing custom Python scripts, processed network datasets and a README file for the study.

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Xiang, B., Hong, M., Guo, F. et al. Unequal spatial patterns and differentiated city roles in the intercity telemedicine system. Nat Cities (2026). https://doi.org/10.1038/s44284-026-00442-y

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