Chinese Patients’ Willingness to Use Virtual Visits During and After the COVID-19 Pandemic: Repeated Cross-Sectional Study in Zhejiang Province, 2021-2024

BACKGROUND: The COVID-19 pandemic has been a critical external driver of telemedicine adoption. As the pandemic entered its later stages, countries worldwide transitioned from stringent containment measures to routine management. This policy shift may in turn have shaped patients' willingness to use (WTU) telemedicine. OBJECTIVE: This study aims to examine the changes in patients' WTU virtual visits during and after the COVID-19 pandemic in China, with particular attention to the policy transition from stringent containment to routine pandemic management, and to identify factors associated with patients' WTU across different survey years. METHODS: Repeated cross-sectional surveys were conducted among 340, 786, 1179, and 1373 hospital outpatients in Zhejiang Province, China, from 2021 to 2024. Using year as a proxy for the evolving COVID-19 containment policy context, this study used binary logistic regression of pooled 2021-2024 repeated cross-sectional data to examine whether survey year was significantly associated with patients' WTU virtual visits. Separate year-specific binary logistic regression was fitted to identify factors associated with patients' WTU in each survey year. RESULTS: The proportion of patients' WTU virtual visits was 70.88% (241/340) in 2021, 71.37% (561/786) in 2022, 62.34% (735/1179) in 2023, and 75.38% (1035/1373) in 2024. In the pooled 2021-2024 repeated cross-sectional analysis, survey year was significantly associated with patients' WTU: compared with 2021, patients' likelihood of being willing to use virtual visits was lower in 2023, but higher in 2024. In the year-specific analyses, educational level and primary source of information were consistently associated with patients' WTU across all 4 years. Visiting hospital tier was additionally associated with WTU in 2022; age and visiting hospital tier were associated with WTU in 2023; and age, monthly income, and self-rated health status were additionally associated with WTU in 2024. Joint Wald tests of year-by-covariate interactions confirmed that the associations of age, visiting hospital tier, monthly income, and self-rated health with WTU varied across survey years. CONCLUSIONS: Patients' WTU remained high across the 2021-2024 transition from stringent COVID-19 containment to routine pandemic management, declining in the first postpandemic wave of 2023 and then rebounding to its highest level in 2024. The correlates of WTU were only partially stable: a college-level education and internet-based information seeking were consistently associated with higher WTU in both the pooled and year-specific analyses, whereas the associations with age, visiting hospital tier, monthly income, and self-rated health varied across survey years and emerged only in specific periods. These findings suggest that virtual visits gained sustained acceptance among patients in economically and digitally developed regions of China, and that telemedicine platform design should accommodate patients with lower educational levels or limited internet skills while outreach extends across a broader range of age groups to support more equitable adoption.