Telemedicine as a substitute for in-person primary care: Scenarios and boundaries

Yifan Zhao; Dahai Zhao; Yifan Zhao; Dahai Zhao

doi:10.3934/har.2026005

Health Affairs Review

2026, Volume 1, Issue 1: 56-74. doi: 10.3934/har.2026005

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Research article

Telemedicine as a substitute for in-person primary care: Scenarios and boundaries

Yifan Zhao ¹,
Dahai Zhao ^{1,2
,
,}

1.
School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai 200030, China
2.
Yale University-Shanghai Jiao Tong University Joint Center for Health Policy, Shanghai Jiao Tong University, Shanghai 200030, China

Received: 21 April 2016 Accepted: 17 July 2026 Published: 06 August 2026

Background
Telemedicine has become a routine part of primary care, but its relationship with in-person care remains uneven. The question is not simply whether remote care works; it is which parts of primary care can be moved into remote channels and which parts still need face-to-face contact.
Methods
This review examined a corpus of 149 studies and organized the evidence around chronic disease management, mental and behavioral health, triage and resource allocation, and care for marginalized or hard-to-reach populations.
Results
The clearest support was found for stable follow-up, prescription renewal, routine monitoring, selected behavioral interventions, and some standardized screening or triage tasks. The limits are just as visible. First-contact diagnoses, emergencies, complex multi-morbidities, physical examinations, procedures that require touch or equipment, and encounters that depend heavily on trust and non-verbal communication remain difficult to substitute.
Conclusion
A cautious conclusion follows: telemedicine can replace selected tasks and encounters, but not the clinical, relational, and procedural role of in-person primary care as a whole.
- telemedicine,
- in-person care,
- primary care,
- substitution effect,
- evidence synthesis
Citation: Yifan Zhao, Dahai Zhao. Telemedicine as a substitute for in-person primary care: Scenarios and boundaries[J]. Health Affairs Review, 2026, 1(1): 56-74. doi: 10.3934/har.2026005

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Abstract

Background

Telemedicine has become a routine part of primary care, but its relationship with in-person care remains uneven. The question is not simply whether remote care works; it is which parts of primary care can be moved into remote channels and which parts still need face-to-face contact.

Methods

This review examined a corpus of 149 studies and organized the evidence around chronic disease management, mental and behavioral health, triage and resource allocation, and care for marginalized or hard-to-reach populations.

Results

The clearest support was found for stable follow-up, prescription renewal, routine monitoring, selected behavioral interventions, and some standardized screening or triage tasks. The limits are just as visible. First-contact diagnoses, emergencies, complex multi-morbidities, physical examinations, procedures that require touch or equipment, and encounters that depend heavily on trust and non-verbal communication remain difficult to substitute.

Conclusion

A cautious conclusion follows: telemedicine can replace selected tasks and encounters, but not the clinical, relational, and procedural role of in-person primary care as a whole.

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