BACKGROUND: The widespread of telehealth has not only improved medical service accessibility and convenience, and has also played an active role in the COVID-19 Epidemic. This suggests that telehealth is becoming increasingly important in both normality and emergency. It is therefore essential to evaluate the use of the technology and its impact on the healthcare system. OBJECTIVE: This paper studied the use of telehealth in China, the socio-demographic characteristics of users, its impact on patients' choice of first-visit, and potential health inequalities. METHODS: We obtained 14,944 valid questionnaires from a multistage stratified sample of 41 cities in the Yangtze River Delta, China, and multinomial logit was mainly used. RESULTS: The utilization rate of telehealth in the study area was 10.43%. Residents that were younger, more educated, had higher household incomes, were more health literate, used more adequate medical insurance, ordered food delivery more often, and had chronic diseases were more likely to use telehealth. Residents who used telehealth had significantly higher odds of choosing high-level hospital instead of primary care provider as their first visit (B = 0.168, P <
0.05
B = 0.192, P <
0.05). And this substitution effect is more pronounced among the younger, more educated, and higher household income residents. CONCLUSIONS: Telehealth is still underutilized in China's actual healthcare services, and use of telehealth is more likely to be seen among younger, higher-income, and well-educated groups. The use of telehealth may lead residents to skip primary health care more easily and occupy secondary and tertiary health care inappropriately. It maybe impacts China's hierarchical medical system, and further leading to new potential health inequalities due to the "digital divide".