The bibliometric methodology used in this study describes the landscape and core topics of research in the field from a perspective of health insurance in the advancement in digital health care in China from 2000 to 2022.

Bibliometrics is a method of information analysis, which measures research trends and knowledge structures in a field of research to obtain quantifiable, objective data [11]. The method has been extensively used to quantitatively analyze academic literature to describe trending topics and contributions of scholars, journals, and countries and help researchers understand the current research trends, distribution, and core topics in a given field [12,13]. VOSviewer has better visualization in network and cluster analysis than other software, and the scientometric graphs conform better to current academic research styles. VOSviewer was developed by Nees Jan van Eck and Ludo Waltman and features a powerful bibliometric maps function that can clearly visualize the network of literature, keywords, authors, etc [14]. Using VOSviewer, we generated diagrams for institutional cooperation, keyword co-occurrence, author cooperation, and author cocitation, and the Chinese-language data are all retrieved from the China National Knowledge Infrastructure (CNKI) database [15].

All articles related to the fields of health insurance in telemedicine and IPHC published from 2000 to 2022 and written in Chinese are included (Multimedia Appendix 1). The reason why the beginning year was set as 2000 is that China did not formally establish its current concept of a health insurance system until 1999 [1,2].

We set the CNKI as the target database and retrieved data from “Chinese Journal Full-text Database” and “Academic Journals” (excluding dissertations, conference proceedings, and newspapers). On April 5, 2023, we selected the “Advanced Search” feature and set the search strategy as follows: “(Topic: telemedicine (exact) OR Topic: internet plus healthcare (exact)) AND (Topic: health insurance (exact) OR Topic: medical security (exact)) AND (year range 2000-2022)” to select studies from 2000 to 2022; this yielded 659 articles.

A total of 659 articles retrieved from the search were imported into Excel (Microsoft Corp) for manual checking, and we excluded 6 duplicates papers and then 238 publications belonging to other categories (such as press releases, editorial comments and short reports, nonacademic articles) and 4 publications outside of the time range of 2000-2022 to obtain a final selection of 411 articles; the refinement process is shown in Figure 1. These 411 entries were manually checked to ensure correspondence between the authors and their affiliations, especially when multiple authors are affiliated with the same institution—this step is crucial as it helps avoid potential errors.

We then exported the data and imported them into VOSviewer software (version 1.6.19) for cluster analysis. Based on cluster results, we analyzed and summarized the articles.

Based on the publication year in the research literature, it can be observed that between 2000 and 2015, the number of articles published in the field of IPHC, remote medical services, and health insurance services was <10 each year, and the accelerated growth started in 2015. Since the number of publications approached 14 in 2015, from 2017 to 2019, the number of articles published in this field plateaued around 30 to 40. In 2020, the number of publications in this research field increased rapidly to nearly 100 papers (around 90 a year) and remain high at about 80-90 papers in 2020 and 2021. Index regression predicts that there will still be a number of Chinese studies published in this field in the near future, while the R² value of the regression model is 0.6788, indicating that the curve explains the variables relatively well.

Table 1 shows that journals whose scope includes health insurance focus more on this research field; China Health Insurance Journal accounts for 6.8% of the proportion of studies in this field. Second, journals that explore digital medicine take the lead. China Digital Medicine accounts for 4.8% of studies in this regard, followed by other general medical and health policy research journals. Regarding the distribution, core journals included in Chinese core journals indexed by Peking University or the Chinese Social Sciences Citation Index, both of which are top core collections of Chinese-language journals, enjoy widespread prevalence. The top 5 journals are core Chinese-language journals.

This field is in its infancy; hence, the top cited article in this field is a study analyzing the basis of this field. The article containing definitions came first, occupying the forefront, received 201 citations (Table 2). Then, latter research focused on currently established modules, problems faced, and future development trends. They all attempted to establish theories and models needed in this field systematically.

Analysis of the author cooperation network revealed that 811 authors had explored health insurance in IPHC and telemedicine, of whom 9 have acquired more than 12 total link strengths (Figure 2), namely total link strength (TLS), reflecting the strength of cooperation in bibliographical analysis (Table 3). Xu Hong and Lyu Dawei, who discussed the prospect of IPHC in cooperative development of the Changjiang river delta, are the most active authors in this field. The latter active authors also gained over 10 TLSs.

A total of 62 institutions were finally included, with a minimum limitation of more than 3 publications, whose publications were analyzed using VOSviewer (Figure 3). Moreover, the School of Health Policy & Management, Nanjing Medical University (TLS=6 times) and other 10 institutions were the top institutions with highest TLS in VOSviewer counting (Table 4). Total link strength and institution co-occurrence of publications.

Identifying trending research fields and directions through keyword co-occurrence analysis is an important indicator for monitoring the development of a discipline. Mapping of keywords is shown in Figure 4, where the size of the node represents the frequency of keyword occurrence, and the lines between the nodes reflect the co-occurrence relationships among multiple keywords. According to the mapping image generated by VOSviewer, current hot topics in Chinese literature in this field can be visually described.

This study analyzed 290 Chinese-language keywords that appeared at least 10 times across included publications using VOSviewer. The results were grouped into 5 clusters: “Telemedicine,” “Internet hospital,” “Internet Plus Healthcare (IPHC),” “Health Insurance Payment,” and “Health Insurance system.” These clusters provide insight into the most prominent topics related to the use of health insurance in IPHC and telemedicine (Table 5).

Based on the 5 keyword clusters, the hot spots in the field are described below.

Our study shows that in the digital era, China’s health care service system is facing the need for payment mechanisms and policy adjustments to support and optimize the hierarchical health care system. The practice of internet hospitals, as a part of IPHC, has demonstrated the potential for insurance payment in web-based health care services, but it has also revealed challenges in regional integration and interregional coordination. Insurance payment reform, as a key lever for driving systemic change, relies on the advancement of digitalization and informatization, as well as continuous investment in electronic medical records, IT, and primary health care services. Future research and policy making must focus on addressing the integration of technologies with administrative systems, promoting the development of mobile health care, and exploring the interoperability between health care insurance payment systems to achieve efficiency and standardization in health care services.

According to our results, there has been significant development in areas of health insurance in IPHC and telemedicine research over the past 2 decades. The number of relevant publications has steadily increased year by year, and more than 60 researching institutions and over 800 authors in China have published academic research papers in this field. Since 2017, the number of publications in this field has risen sharply from around 30 papers each year to around 90 papers each year, which means that in the near future, an increasing number of studies will focus on the use of health insurance in IPHC and telemedicine, especially in improving health insurance implementational methods and measures, and future patching policies regarding digital health care services.

In the founding stage of the research field, the most highly cited paper was an analysis of its theoretical basis, with 201 citations, occupying the top spot, having focused on established modules, current challenges, and future development trends, striving to systematically develop theories and models required for the field.

Among 62 institutions, over 10 of them had a TLS of 6 and rank at the top.

There were 62 institutions with a minimum of >3 publications; among them, 11 institutions with 6 TLSs were the top academic institutions. These research institutions include universities, hospitals, and associations in the health care industry, implying that this research field has received widespread attention in Chinese academic fields and reflects the importance of research in this field in China. Different types of institutions engage in academic discussions from their specific perspectives.

Through bibliometric and visualization analysis, we gained a deeper understanding of the overall landscape of this research field, including prominent Chinese authors and publishing institutions, as well as their collaborative relationships and academic influence. This information provides researchers with transparent channels for selectively obtaining advanced and valuable research results. Co-occurrence analysis can also depict research trends and hot spots [22], providing researchers with assistance in proposing research topics to convince funding agencies to develop more effective funding plans.

To the best of our knowledge, no study has carried out bibliometric analysis in this field of research on the use of health insurance in IPHC services, along with telemedicine. It is of noticeable significance to discuss these issues and it is now necessary for us to study the research topic and identify hot spots. The method of bibliometrics and visual analyses enable us to sort out research focuses in recent publications as well as their correlation and differentiation.

However, this study inevitably has some limitations. We only retrieved studies and reviews on research topics related to this field from the CNKI. Although the CNKI plays a significant role in academic research and literature analysis in China, there are some obvious limitations to its application in international research fields, and studies need to consider these limitations and comprehensively integrate database resources in accordance with the specific needs of the research, to ensure comprehensive evaluation and analysis. Therefore, we may have missed some publications due to database limitation, and articles related to other languages may not have been included.

Bibliometric methods provide an overall insight into the landscape of a specific research field, but researchers and policy makers should be aware that the feature is not detailed enough for the evaluation or decision-making, and this study provides no enough in-depth insight into the influential articles and authors in this field. Balanced approaches that integrate bibliometrics research with other assessment methods can provide a thorough understanding of research impact and trends.

Recently, many previously ignored issues have been discussed and are now at the forefront, and numerous real-world problems associated with internet-based health care services, which has been limited by the scale of services, have been pointed out and discussed. Starting from the postpandemic era, the demand for remote or IPHC services will continue to grow. The deepening support of policies for IPHC services can meet the demand for health insurance management, mobile insurance payment, and cost reduction. Future research hot spots are developing, such as those focusing on the web-based application of live broadcasting, new media, artificial intelligence technology, etc, into IPHC services. Other hot spots include chronic disease management and primary health care, as well as the community older adult care in health insurance reforms in the IPHC era. These hot spots are surely important for suggesting more reasonable policy measures, enhancing the accessibility of health care services, reducing costs, and improving the quality of health care, thus better serving the people requiring them.

In summary, this study on the application of health insurance in internet-based health care services is quite forward-looking, and it is an important frontier for future health care service research.

This study describes a bibliometric analysis of the current high-quality Chinese literature on the application of telemedicine and IPHC in health insurance in China. This study used the popular software tool VOSviewer (version 1.6.19) to analyze the literature published in the CNKI, which was involved in the development of this field, and provides an overview of all the existing high-quality Chinese research and guides future research developments to improve the application of telemedicine and IPHC in health insurance. In particular, the unique IPHC paradigm from China is of importance to health care professionals worldwide.

This study used bibliometric analysis to describe the current situation and trends of health insurance in IPHC and telemedicine from the literature in China. This study highlights prominent research institutions, hospital researchers, and researchers at research institutes in universities engaged in this field. More articles on health insurance in IPHC and telemedicine are expected to be published in the next few years. The use of internet hospitals has underscored the potential of health care insurance payment in IPHC services, but it also highlights challenges pertaining to regional integration and interregional coordination. As the key lever for instigating systemic change, health care insurance payment reforms hinge on the progression of digitalization and informatization, along with ongoing investment in electronic medical records, IT, and primary health care services. Future research and policy formulation are expected to focus on tackling the integration of technologies with administrative systems, fostering the advancement of mobile health care, and delving into the interoperability among health care payment systems to attain efficiency and standardization in medical health care. This research provides an invaluable reference, enhancing our grasp of the current landscape and prospective progress in the field of health insurance within the domains of IPHC and telemedicine.