Consultations with doctors are the most frequent contact most people have with health services and provide an entry point for subsequent medical treatment. Consultations can take place in different settings and during the COVID‑19 pandemic the use of teleconsultations was crucial to continue to deliver care safely. On average across EU countries, in-person consultations fell by almost 20% in 2020, but the declines were almost completely offset by increasing numbers of teleconsultations in some countries such as Belgium, Croatia, Czechia, Estonia, Portugal and Spain.
At the beginning of the pandemic, governments acted rapidly to promote the use of teleconsultations by introducing enabling legislation and revising laws. After the pandemic started, at least four EU countries that previously allowed only in-person consultations (Estonia, Hungary, Ireland and Luxembourg) dropped this restriction. France and Lithuania relaxed their prerequisite that patients were only allowed to have teleconsultations with doctors they had already consulted in person. Additionally, volume restrictions on physicians providing remote consultations were lifted in Germany and Sweden. Governments also promoted the use of telemedicine through changes in providers’ payment systems. At least six EU countries began covering teleconsultations through government/compulsory schemes (Belgium, Czechia, Estonia, Hungary, Latvia and Luxembourg) (OECD, 2023[1]).
Even before the start of the COVID‑19 pandemic, teleconsultations between doctors and patients were used extensively in countries such as Denmark. These teleconsultations were made possible through different options such as the national “My Doctor” mobile application that was set-up as part of Denmark’s Digital Health Strategy 2018‑22. Since 1 January 2022, video consultations have become a permanent consultation option (OECD/European Observatory on Health Systems and Policies, 2023[2]).
In 2022, teleconsultations accounted for an average of 16% of all doctor consultations across 16 EU countries with available data (Figure 8.9). Spain, Portugal, Estonia and Denmark reported the highest rates, with over 25% of all doctor consultations being conducted remotely. While teleconsultations increased during the pandemic in Belgium, France, Germany and Luxembourg, they only comprised 2% to 6% of all doctor consultations in these countries in 2022.
Looking at trends between 2018 and 2022, in many countries the volume of teleconsultations reached a peak during the first two years of the pandemic in 2020 and 2021, and then started to decrease in 2022, but nonetheless remained higher than pre‑pandemic levels. Croatia, Estonia, Portugal and Spain had among the largest increases in 2020 and 2021, followed by a subsequent decline in 2022 except in Estonia where the volume remained stable (Figure 8.10; left panel). The volume of teleconsultations also increased substantially in Belgium and Czechia in 2020 and 2021, followed by a reduction in 2022. The growth in 2020, 2021 and 2022 was relatively more modest in France and Germany (Figure 8.10; right panel).
Across the EU, patients who used teleconsultations and other telemedicine services during the pandemic were overwhelmingly satisfied. There is ample evidence that telemedicine services can save patients money and time. Doctors had more mixed views of the importance of teleconsultations and other remote care services, and some physicians expected to reduce their provision of telemedicine services or even stop providing them altogether following the peak of the pandemic in 2020 and 2021. Access to telemedicine among certain groups of patients also remains a key concern in several countries (OECD, 2023[1]).
While the pandemic required the urgent expansion of telemedicine as a substitute for in-person care, three gaps in implementation might have limited the potential impact of telemedicine services. First, there has been a significant gap in measurement and evaluation, hindering the ability to understand patient usage patterns, access barriers, outcomes and the overall effectiveness of telemedicine. Second, existing payment mechanisms might not have effectively incentivised cost-effective utilisation of telemedicine services, leading to uncertainties around value for money. Third, the fragmentation of care services between in-person and remote services presents challenges in providing seamless and integrated care pathways for patients. In the post-pandemic period, countries need to explore further how to integrate telemedicine into routine care pathways responsibly and use evidence to shape policies for the sustainable and equitable delivery of healthcare in-person and through telemedicine.
