Introduction: A Two-Decade Journey in Indian Telemedicine
India’s telemedicine landscape spans more than 20 years, evolving from satellite-based links between rural spokes and urban hubs to a nationwide digital health ecosystem. A scoping review of telemedicine services initiated between 2000 and 2023 maps what has worked, what has scaled, and where evidence remains thin. The findings shed light on model types, scale, stakeholders, and the economic dynamics shaping remote care in a populous, diverse country.
Key Models and Scale: Public, Private, and PPP Approaches
Studies show a spectrum of delivery models, including patient-to-provider, provider-to-provider, and hybrid arrangements. Large-scale programs often rely on specialized software that enables bidirectional data sharing and integration with health records. In India, private sector initiatives frequently expand access through hospital networks or technology platforms, while public programs emphasize broad reach via government-backed channels such as eSanjeevani. Public-private partnerships (PPP) emerged as a vital mechanism to extend services to underserved areas, balancing scalability with public accountability.
Real-Time Versus Deferred Care
Most large-scale services deliver care in real time (synchronous) but a significant share combines synchronous and asynchronous modalities. The mix reflects practical constraints, patient preferences, and the need to document interactions for clinical and billing purposes. The review highlights that asynchronous tools, including text messages or store-and-forward exchanges, can complement live consultations, especially where bandwidth or provider availability is limited.
Who Delivers Care and Who Benefits
Across the examined programs, MBBS doctors and specialists provided clinical care, with allied health professionals and AYUSH practitioners participating in a smaller but meaningful share. The patient-to-provider model dominates private-sector offerings, where hospitals and tech vendors create patient-facing telemedicine experiences. Public-sector services frequently combine patient-to-provider and provider-to-provider models, signaling telemedicine as both an access tool and a health system-strengthening intervention.
Reach, Access, and Equity: What the Data Show
Reach varies widely. Some programs report millions of patients served and tens of millions of consultations, while others operate in a single state or district. National initiatives like eSanjeevani demonstrate rapid scale, with hundreds of thousands of providers and hundreds of millions of health interactions. Yet, uptake is not uniform. Barriers—such as women’s access to personal mobile devices and rural connectivity—limit reach. The evidence base on health outcomes and equity remains uneven, underscoring the need for standardized metrics in future work.
Evidence of Effectiveness and Costs
Evidence on effectiveness exists for a subset of services, with quasi-experimental and observational studies illustrating improvements in certain settings (for example, pediatric HIV care and telepsychiatry). Other studies report comparable diagnostic capabilities to in-person care, while some show mixed results in population health outcomes or service utilization. Cost analyses are scattered, highlighting the importance of transparent cost data, patient savings, and the true economic value of telemedicine in different contexts.
Lessons for Future Telemedicine in India and Beyond
From the twenty-year perspective, several lessons emerge: (1) scale favors programs with integrated software and clear governance; (2) mixed delivery models (public, private, PPP) are necessary to maximize reach; (3) evidence generation must catch up with rapid deployment, using standardized outcomes and health-economic metrics; (4) equity considerations—especially gender and rural access—must be central to design; (5) governance and data privacy are critical as services scale across states. The Indian experience offers a blueprint for other low- and middle-income countries aiming to improve timely access to care using digital health tools.
Conclusion: A Benchmark for Digital Health Policy
India’s telemedicine evolution demonstrates the potential of ICT-enabled care to expand access and equity, while also revealing gaps in evidence and data interoperability. Policymakers, providers, and researchers can use these lessons to tailor scalable, evidence-informed telemedicine strategies that deliver safe, high-quality care for diverse populations.
