Article
Cross-Border Telemedicine and Digital Healthcare Delivery: A Systematic Review of Licensure, Liability, Reimbursement, and Data Governance
Cross-border telemedicine turns a clinical encounter into a multi-jurisdictional transaction. The provider, patient, payer, platform, data processor, and medical record may each be located under different legal regimes, making ordinary telehealth rules difficult to apply at scale. This systematic review and comparative legal-policy analysis examines four domains that most directly determine whether cross-border digital care can operate lawfully and sustainably: professional licensure, malpractice liability and jurisdiction, reimbursement, and health-data governance. Open-access scholarly literature published from January 2020 through August 29, 2026 was systematically searched and synthesized with current primary legal and regulatory materials from the United States, Minnesota, the European Union, India, the World Health Organization, and the World Trade Organization. Eighteen scholarly sources met the final inclusion criteria. The evidence shows that regulatory fragmentation, rather than lack of clinical technology, is the recurring constraint. U.S. interstate practice remains anchored largely to patient-location licensing, although compacts and registration pathways reduce transaction costs. Minnesota provides a notable registration pathway for out-of-state physicians and statutory private-payer telehealth parity. In the European Union, Directive 2011/24/EU, the 2025 DrSmile judgment, and the European Health Data Space create a more integrated framework, but liability, reimbursement, and hybrid-care questions remain only partly harmonized. India has a detailed domestic telemedicine framework and insurance guidance but no comparable cross-border recognition regime. The review proposes a layered compliance model that links market entry to licensure, allocates liability before care is delivered, makes payment rules portable and transparent, and treats interoperable data governance as core infrastructure rather than an ancillary privacy obligation.