The unequal distribution of medical resources is a global issue, particularly in remote areas where access to health care is severely limited.

Telehealth presents an effective solution to address this disparity in health care resources. Its primary aim is to enhance health care access by providing services to individuals who face barriers to obtaining care [1]. Initially, telehealth was employed to treat acute conditions, such as trauma or stroke [2]. As health care demands have risen, telehealth has expanded to include care for military personnel, prisoners, and rural populations [3]. While telehealth has significant potential, its development depends on conditions such as network infrastructure and coverage. Mobile clinics provide an additional solution to the unequal distribution of health care resources. Mobile clinics are mobile health care units, typically modified ambulances, designed to deliver services to both urban and rural communities [4]. This flexible health care model overcomes both time and geographical challenges, bringing medical services directly to remote areas. However, the limited space in the mobile clinic restricts the number of staff and equipment available, making it difficult to meet the diverse health care needs of residents [5].

In Lishui City, Zhejiang Province, China, an innovative integration of telehealth and mobile clinics has resulted in the creation of the intelligent mobile clinic. This model effectively combines the strengths of both telehealth and mobile clinics to address the health care needs of those in mountainous regions.

In this study, we introduce an innovative medical model for improving medical services in remote mountainous areas in Lishui City, Zhejiang Province, China. We will use the application, effectiveness and difficulties of the intelligent mobile clinic model in remote mountainous areas of Lishui City to provide reference experience for other remote areas to improve the uneven medical resources and provide high-quality medical services.

China is a predominantly agricultural country with a large rural population. As of 2022, the rural population in China reached 491.04 million, accounting for 34.78% of the total population [6]. Residents in remote areas face difficulties accessing health care due to factors such as economic constraints, distance, and time limitations [7-9]. For example, they have to spend a whole day seeking medical treatment, and some people may not even know that they are sick until their condition is very serious or has reached an advanced stage [10].

In response, the development of rural health care and medical systems has been the core of the new health care reform launched by China since 2009, which aimed at narrowing the urban-rural and regional disparities [11]. However, despite government efforts to implement medical reforms, there are still issues such as disparity distribution of health resources, a shortage of medical personnel, and inefficiencies in medical services [11,12]. Recognizing these challenges, the Chinese government has introduced various methods. One such method is the use of telehealth. Previous research has confirmed that telehealth can save residents time and costs in seeking medical treatment and promote the management of chronic diseases [13,14]. However, telehealth has not fully filled the health gap in rural areas, mainly due to young people flocking to urban centeres in search of better opportunities. This migration has left rural areas with a population dominated by older persons who face significant challenges in accessing and using e-health resources [15]. Consequently, these barriers prevent elderly residents from fully benefiting from telehealth services, exacerbating the health care disparities between rural and urban areas.

To address these challenges, China has been exploring innovative telehealth models that better suit the country’s unique circumstances in recent years.

A notable example is Lishui City, where a new solution has been introduced to address the specific health care needs of its rural population.

Lishui City is located in the mountainous region of southwest Zhejiang Province, where rugged mountains and hills dominate, with mountainous areas covering around 90% of the total land area. The region is home to more than 250 mountain villages, most of which are situated over 80 kilometers from the town center. Despite the local government’s efforts to improve health care services, the spread-out population and small village sizes make it difficult for health care to reach every village, failing to meet the basic health care needs of the residents. As a result, residents often face long journeys, taking an entire day to reach a health care facility.

In Lishui’s mountainous areas, as is the case in many rural parts of China, the population is largely elderly. These individuals often face additional challenges such as illiteracy, difficulty speaking Mandarin, and an inability to use smartphones or other smart devices. Although telehealth has significant potential to improve health care access, it struggles to address these issues in Lishui’s rural context. As a solution, the government of Lishui City has developed the intelligent mobile clinic, which delivers more accessible and effective health care services to the rural population. The intelligent mobile clinic represents an innovative response to the distinct needs of Lishui’s residents. The next section will provide a detailed introduction to the intelligent mobile clinic.

The intelligent mobile clinic offers an innovative solution by combining mobile clinics, telehealth, 5G technology, and big data to tackle the unequal distribution of medical resources in remote areas. This model integrates several advanced technologies to provide high-quality and accessible health care services to people in remote regions (Figure 1).

The intelligent mobile clinic utilizes modified medical vehicles, equipped with essential diagnostic tools, to deliver health care services to even the most remote mountainous areas. These vehicles provide services such as routine health check-ups and rapid laboratory tests. When the doctor encounters cases that surpass their expertise, the telehealth system connects them with specialists at higher-level hospitals. This real-time consultation enables more accurate diagnoses and effective treatments, even in distant locations.

The roles of 5G and big data are pivotal in supporting the intelligent mobile clinic. 5G technology ensures smooth communication and the real-time transfer of medical data, while big data helps gather and analyze health information to refine services, monitor regional health trends, and improve the distribution of medical resources.

From 2018 to the end of 2023, the intelligent mobile clinic had a total of 50 mobile medical vehicles, a total of 18,000 visits, 100 years of travel within the area of 10,000 kilometers, a total of 25,000 village medical services, 33,000 medical personnel, a total of 657,000 services, covering 758 remote villages without medical facilities (Table 2). In addition, the average emergency response time in mountainous areas reduced from 34 minutes to 14 minutes. According to data from the Lishui government, the goal of mountainous residents to have “shorter medical treatment times and the ability to address minor illnesses within the village” has increasingly become a reality.

The emergence of the intelligent mobile clinic has effectively alleviated the unequal distribution of medical resources in remote mountainous areas of Lishui City, and increasing numbers of villagers can get timely treatment. As noted earlier, the population in the remote areas of Lishui is spread across the mountains, making it difficult for residents to access medical resources from urban areas. Building hospitals in these regions would serve only a small portion of the population, potentially resulting in a waste of resources. Additionally, many residents in these mountainous areas are elderly and face challenges such as illiteracy, an inability to speak Mandarin, or limited access to the internet. These factors mean that internet hospitals and mobile clinics may not fully meet their needs. Each region has its own unique circumstances, and local governments must carefully assess these conditions and implement appropriate measures to provide suitable services for residents, such as capsule clinics in Ningbo or internet hospitals in Guangzhou. The intelligent mobile clinic is a new health care service model that integrates the advantages of telehealth and mobile clinics, developed by the local government to address the specific conditions of the area. With the guidance of big data, the intelligent mobile clinic is able to deliver accurate health care services to residents in remote mountainous regions. Medical staff from the intelligent mobile clinic also help elderly residents communicate with specialists through the internet.

The intelligent mobile clinic presents an innovative and effective solution for promoting the equal distribution of medical resources in remote areas. By combining the benefits of telehealth and mobile clinics, the intelligent mobile clinic tackles the health care challenges in the mountainous regions of Lishui. The success of the intelligent mobile clinic in Lishui offers a valuable example for addressing similar issues in other remote areas of China and even in countries facing comparable challenges.

Nonetheless, each region must carefully evaluate its specific circumstances and develop suitable approaches to meet the health care needs of its residents, ensuring a balanced distribution of medical resources across various areas.