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Economic analysis busts telemedicine myths

Stanford researchers find that increased telemedicine does not raise costs of health care or jeopardize quality of care.

For years, telemedicine didn't take off, despite expectations it would revolutionize health care delivery. In the United States, for example, remote visits accounted for a slim percentage of primary care visits before 2020.

The COVID-19 pandemic changed all of that. Stay-at-home orders and regulatory changes fueled an unprecedented surge in virtual doctor visits.

At Stanford Health Care, for example, fewer than 2% of patient visits were conducted virtually in 2019. But by mid-April 2020, just a month after Bay Area counties issued stay-at-home orders to keep the coronavirus from spreading, 70% of visits were virtual.

Though there are concerns that telemedicine could result in lower-quality care and contribute to higher costs, a Stanford Institute for Economic Policy Research working paper posted in June found that such fears are likely overblown.

Researchers used medical records from Israel's largest health care provider to analyze the impact of telemedicine in the country and found that increased access to telemedicine resulted in lower costs, without signs of negative outcomes.

"Policymakers or doctors or patients should find more comfort that scaling up telemedicine is not harmful," said Liran Einav, PhD, a Stanford University professor of economics and a co-author of the paper, which hasn't yet been peer-reviewed.

A win-win

Like much of the world, Israel went into lockdown as COVID-19 cases began to surge in March 2020. In the following weeks, telemedicine uses for primary care soared from 5% to 40%. Usage remained high -- at 20% -- even after Israel returned to a short period of relative normalcy in May. This coronavirus timeline gave researchers an opportunity to explore what telemedicine use might be like post-pandemic.

By analyzing Clalit Health Services records for 12 million primary care visits, researchers identified patients with access to remote care and showed that increased telemedicine access resulted in a 3.5% increase in primary care visits. But, the overall cost of services used in the 30 days following an initial visit was 5% lower.

The researchers also analyzed three medical conditions -- urinary tract infections, heart attacks and bone fractures -- in closer detail. For all three, they found that access to telemedicine didn't result in missed diagnoses or negatively impacted treatment.

"I don't think there's much of an argument here: Medical care that makes sense to shift to telemedicine leads to a better, less expensive experience for everyone," Einav said. "It's a win-win as long as quality of care doesn't suffer."

There may also be additional benefits of telemedicine, such as increased convenience and improved access, the researchers concluded. While the results suggest that telemedicine can improve patient care, there are still open questions regarding its future.

"More research and more statistical power is needed to know how we should regulate it and where we need to draw the line on the type of remote care that should be allowed versus not allowed," Einav said.

This is a condensed version of story from the Stanford Institute for Economic Policy. Read the full story here.

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