The medical expenses of cancer patients have been rising worldwide, and the current payment system based on diagnosis‐related groups is limited in reflecting the actual burden at the patient level. We aimed to develop a prediction model for reasonably high cost of hospitalization, taking gastric cancer (GC) patients undergoing surgery as an example.

In this real‐world patient cohort study, we collected clinical data from 3981 GC surgery inpatients in a tertiary hospital in Beijing, China. Reasonably high cost was defined as exceeding the 75th percentile of the hospitalization costs. The final model for reasonably high cost was derived based on univariate and multivariate unconditional logistic regression, with predictors selected according to the Akaike information criterion. Model performance was evaluated in terms of discrimination and calibration.

The final model consisted of 13 predictors, with the area under the receiver operating characteristics curve of 0.718 (95% confidence interval: 0.700–0.736). Leave‐one‐out cross‐validation generated an area under the receiver operating characteristics curve of 0.708 (95% confidence interval: 0.690–0.727). No significant differences in model discrimination were detected among the subgroups stratified by gender, age, N stage, surgical method, and admission year. The calibration plot showed good agreement between predicted probability and observed frequency of reasonably high cost.

Our prediction tool for reasonably high cost of GC surgery patients has demonstrated good performance. The combined use of diagnosis‐related groups payment and reasonably high cost assessment is expected to promote individualization and precision in medical cost control and ensure rational, efficient, and equitable provision of medical services.

The scarcity of healthcare resources and inadequate access to medical services in rural and remote areas are pervasive challenges many countries face, particularly in the developing world. Telemedicine, with its capacity to overcome geographical barriers and provide patients with real‐time medical services, has shown considerable potential in addressing these issues, attracting widespread attention. Compact medical communities and family doctor systems play important roles in improving healthcare accessibility. However, despite the critical nature of patients' perceptions of healthcare accessibility, research in this domain is sparse. This study aimed to explore the impact of telemedicine on rural residents' perceived healthcare accessibility in China, analyze the mechanisms underpinning this relationship, and elucidate the roles of compact medical communities and the family doctor system.

Survey data from 3311 rural residents were analyzed using a probit model, instrumental variables, and subgroup regression analyses to ascertain causal effects, perform heterogeneity analysis, examine mechanisms, and ascertain the robustness of the findings.

Telemedicine significantly enhanced rural residents' perceived healthcare accessibility, with particularly notable benefits for those in sparsely populated areas, regions with high‐speed internet access, within the purview of compact healthcare consortiums, and those with access to family doctor services. Furthermore, telemedicine improved rural residents' perceived healthcare accessibility by encouraging the use of primary care services.

Telemedicine in China has played a significant role in improving the perceived healthcare accessibility among rural residents and aiding in the reduction of disparities in accessibility across different demographic groups. This is consistent with the broader objective of achieving universal health coverage. However, the efficacy of telemedicine in enhancing healthcare accessibility is contingent upon certain preconditions. Policymakers must confront local infrastructure challenges, particularly regarding internet connectivity, when expanding telemedicine services to ensure their effective operation. The synergistic interaction observed between telemedicine, the family doctor system, and compact medical communities highlights the importance of integrating telemedicine into existing healthcare systems. Such integration could enhance collaboration with current healthcare frameworks, ensuring the provision of safe, accessible, and affordable healthcare services, and promoting the health and well‐being of local populations.