The use of telemedicine was quite limited in most OECD countries before the COVID-19 pandemic, held back by regulatory barriers and hesitancy from patients and providers. In early 2020, as COVID-19 massively disrupted in-person care, governments moved quickly to promote the use of telemedicine. The number of teleconsultations skyrocketed, playing a vital role in maintaining access to care, but only partly offsetting reductions in in-person care. This report provides an overview of the use of telemedicine in OECD countries, describing how governments scaled up remote care during the pandemic and exploring the impact that this massive shift to remote care has had on health care system performance. Telemedicine may be here to stay, but questions remain concerning how to regulate its use, how to pay for it, how to integrate it with in-person care, and how to make sure that it constitutes good value for money for all. This report puts forth priorities for policy makers to inform the discussion and to promote the best use of remote care services in the future.
The COVID-19 Pandemic and the Future of Telemedicine
Abstract
Executive Summary
In early 2020, as countries grappled with the enormous uncertainty surrounding the spread of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) and the disease it caused, COVID‑19, normal life came to a halt. With governments focused on preventing and treating COVID‑19, and people drastically altering their behaviour to limit infection, many in-person health services were postponed or simply cancelled, causing massive disruptions in the delivery of essential health care services, with consequences that persist today.
Faced with significant disruptions to in-person care, governments moved quickly to promote the use of remote care, introducing legislation and revising existing laws. After the start of the pandemic, all nine OECD countries that allowed only in-person consultations dropped this restriction. Three countries allowed prescriptions to be written remotely, and seven countries relaxed a prerequisite that patients were only allowed to have teleconsultations with physicians that they had already consulted in-person before. Governments also promoted the use of telemedicine through changes in providers’ payment systems. After the start of the pandemic, eight countries began covering real-time teleconsultations through government/compulsory schemes.
The number of teleconsultations skyrocketed in the early months of the pandemic, partly offsetting the reduction in in-person care services, and playing a vital role in maintaining access to, and continuity of, care in 2020. Provisional data from OECD show that, due to the boom in remote doctor consultations, the number of total doctor consultations increased in 2020 compared to 2019 in Australia, Denmark and Norway. If not for teleconsultations, in nine OECD countries, doctor consultations would have dropped on average by 14% in 2020, while in fact they only dropped by 3%. In nine OECD countries for which data are available, doctor teleconsultations represented 21% of all doctor consultations in 2020, compared to 11% in 2019. Almost half of all doctor consultations in Denmark in 2020 were teleconsultations.
While access to remote care services among older and poorer patients, as well as those living in rural areas remains concerning, there is evidence that since the start of the pandemic access to remote care has increased for vulnerable groups in some cases. For example, in the United States, in 2021, people aged 51 and older now represent a larger share of all users of remote care, and rates of telemedicine use were highest among patients with lower income. In Canada, in 2020, the highest rates of use were reported among adults aged 65 years and older.
Across the OECD, patients who used telemedicine services are overwhelmingly satisfied. There is also ample evidence that telemedicine services save patients money and time. From a patient’s perspective, telemedicine services represent good value for money: around two in five patients who used remote care services during the pandemic even prefer telemedicine services to in-person appointments.
Physicians have more mixed views of the importance of remote care services, with the pandemic in a new phase in which vaccines are widely available, and in-person services have mostly resumed. Some physicians expect to reduce their provision of telemedicine services or even stop providing them altogether following a period of increased use in 2020. Moreover, changes to promote telemedicine through regulations in 16 countries and through financing in 12 countries are only temporary and subject to review. It is possible that, despite significant demand from patients for remote care services, these will soon become unavailable or subject to stricter regulations.
From the perspective of health systems, it is unclear whether the telemedicine boom during the pandemic represented good value for money. A key underlying uncertainty is whether telemedicine services substitute for or complement in-person care. On the one hand, telemedicine services reduce subsequent (and more costly) health care utilisation and lower the probability that patients miss appointments or decide to forgo care. On the other hand, teleconsultations can lead to subsequent (duplicative) in-person care and, under certain provider payment schemes, may lead to higher spending at no extra value for health systems and patients.
There is a lack of systematic data collection in OECD countries on the reasons why patients use teleconsultations and on the use of health care services following a teleconsultation. Although the COVID‑19 pandemic has created opportunities to explore the impact of remote care services on health system performance, not all countries have taken advantage of these opportunities to collect data and conduct studies. Only ten countries reported data collections on quality indicators such as safety and health outcomes.
This is an appropriate time for debate among stakeholders regarding whether to continue using telemedicine services, how to regulate their use, how to pay for them, and how to make sure that they constitute good value for money for all. Notwithstanding the significant heterogeneity in telemedicine use in the OECD, there are three priorities that policy makers should consider for the future:
Learn more about which patients are using remote care services, why they are using these services and what happens after they use them. This is essential to inform discussions of the impact of telemedicine services on health system performance.
Investigate whether payment and organisational arrangements for provision of telemedicine services, are creating economic incentives that encourage appropriate and effective use of services. It is far from clear that current prices and provider payment mechanisms for remote care services are incentivising and promoting care that is high-quality, delivered at the right time and at the right price. Presently, there are little cost and utilisation data analyses to inform decisions concerning provider payment arrangements and prices.
Foster a model of integrated care delivery in which remote and in-person care services are fully co‑ordinated and part of a seamless care pathway. In-person and remote care services are currently fragmented, with significant disagreement among providers on the merits of telemedicine services. This is not optimal and does not serve the interests of patients.
All three priorities rely heavily on data being collected, analysed and reported. Telemedicine is a tool and, like any other tool, it can be well used or misused. When well used, remote care is beneficial for patients and can add value to health systems, but risks of misuse need to be better understood and minimised.
