Mapping regulatory frictions in telehealth: A spatial accessibility approach using the R-2SVCA model

Existing telehealth accessibility models increasingly account for broadband availability, affordability, and demographic variations, yet largely overlook regulatory constraints that determine whether patients may legally access care across administrative boundaries. To address this gap, we proposed a Regulatory Two-Step Virtual Catchment Area (R-2SVCA) model, which encodes licensure laws and regulations into spatial accessibility measures. Using U.S. telepsychology and the Psychology Interjurisdictional Compact (PSYPACT) as a case study, we demonstrated the framework and compared the R-2SVCA model against a traditional borderless model (as the baseline). The results show that regulatory constraints redistributed accessibility along state lines: populations dependent on cross-border providers experienced significant losses in accessibility due to diminished supply, whereas those served by in-state providers gained accessibility as outbound service was constrained. Furthermore, PSYPACT participation inverted the conventional rural-urban accessibility gradient—benefiting rural residents in member states while disadvantaging their counterparts in non-member states. By explicitly accounting for licensure barriers, this framework provides a robust tool for evaluating telehealth policy and strategically targeting interventions in high-need border regions.