The Swedish Agency for Health and Care Analysis has examined the impact of digital healthcare visits on resource use and equity in healthcare. Data sources include registry extracts of individual-level primary care data from five regions: Stockholm, Västra Götaland, Skåne, Jönköping and Norrbotten.
The report states that digital care has increased significantly since 2016, but still represents a small part of the total number of visits. The costs are approximately two percent of the total costs of primary care.
The report examines several aspects discussed by critics and advocates in recent years. It concludes, among other things, that there is a bias among those who consume digital care.
This is done to a greater extent by highly educated, younger people, people without a chronic illness and people with relatively good socio-economic circumstances. In principle, the opposite applies to physical care. Also corrected for age and chronic illness, digital visits are more common among the highly educated and high incomes.
Here, the analysis of care and nursing points to a problem when it comes to care when needed. It is mainly people with less extensive problems who seek digital care, and “in general, digital visits have reduced the redistributive effect of primary care”.
Another topic that has been extensively discussed has been the regions’ expenditure on digital healthcare, in particular the expenditure on private healthcare providers. Despite the fact that digital visits are on average cheaper than physical visits, and despite the fact that digital visits have partly replaced physical visits, the report concludes that the costs of the regions appear to have increased. This is partly because new healthcare consumption has emerged, and partly because the reduced physical visits have not resulted in lower reimbursement for the health centers. The two different compensation systems – variable compensation for digital visits and fixed compensation for physical visits – make it difficult for the regions to make primary care more efficient in this area. To succeed in this, “more appropriate national and regional reward models are needed”, writes the Health and Care Analysis, and that two parallel reward systems are able to get rid of the current model.
The authority notes that digital healthcare visits have improved both the availability and productivity in primary care in the form of shorter waiting times and lower costs per doctor contact. Digital care can relieve physical care. But there is a lack of knowledge about how the digital visits affect the efficiency of care in general and how they contribute to the health of patients compared to the physical ones. It is therefore difficult to calculate the socio-economic effects, writes Zorg- en Zorganalyse.
– The possibilities for digital healthcare visits are constantly evolving, and the question going forward is how to design the system to get the most benefit. There is a need for ongoing follow-up on how the visits are used and how they contribute to patient health compared to physical visits, said Jean-Luc af Geijerstam, Director General of Health and Care Analysis, in a press release.
The authority also points out that there have long been patient registries that provide a basis for statistics on diseases and treatments in much of the healthcare sector, but not primary care. However, the Board of Public Health and Welfare is working on setting up such a patient register. And given the rapid growth of digital care, it should be included in such a patient register from day one. “Information on digital care should be aligned with the registration of other primary care and collected uniformly across the country,” writes Vårdoch omsorganalys in its report.
Based on the conclusions of the report, the Authority makes three recommendations.
- The regions must continuously monitor and review the incentives generated by their compensation models for digital and physical visits.
- The government and the regions should regularly monitor how digital care affects the efficiency and equality of care.
- The government must ensure that digital visits are included in a national patient register for primary care.
The report »Visits over the Internet« is available at Health and Care Analytics Website†
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