Banning Stefan, Höglinger Marc, Meyer Delia, Reich Oliver
Department of Health Sciences, University of Applied Sciences, Fulda, Germany.
Health Services Research, Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
Telemed J E Health. 2023 Apr;29(4):510-517. doi: 10.1089/tmj.2022.0166. Epub 2022 Aug 29.
Telemedicine health insurance models are highly prevalent in the Swiss health care system. Nevertheless, the potential of telemedicine is only partly being achieved, since current telemedicine health insurance models are limited to an initial contact by telephone and a gatekeeper role that organizes access to health care providers such as general practitioners, specialists, or hospitals. Against this background, a telemedicine device with diverse visual and auscultatory examination functions was made available to 2,000 telemedicine-insured clients. This device allowed diagnostic information to be sent to a medical care provider and used for telemedical consultation. To determine whether the additional implementation of a multifunctional telemedicine examination device resulted in fewer physical consultations, reduced service utilization, and lower health care expenditures among telemedicine-insured clients. Our analysis is based on claims data from 135,636 clients insured in a telemedicine call center model covering the years 2019 and 2020. We compare the use of health care and health care costs of clients who received a telemedicine device with those without such a device, using multivariable regression to adjust for group differences due to self-selection. We found lower total health care expenditures of -229 (Swiss Francs) and lower inpatient costs of -160 (Swiss Francs) on the part of clients with the telemedicine device. However, the implementation of the telemedicine device did not lead to a statistically significant reduction in service utilization. The treatment of telemedicine-insured clients was on average more cost-effective when they received the multifunctional telemedicine device. Accordingly, complementing the existing telemedicine model with telemedicine devices that allow for improved telemedical consultations has the potential to increase the cost-saving potential of the existing telemedicine call center models.
远程医疗健康保险模式在瑞士医疗体系中非常普遍。然而，远程医疗的潜力仅得到了部分实现，因为当前的远程医疗健康保险模式仅限于电话初步问诊以及充当组织患者联系医疗服务提供者（如全科医生、专科医生或医院）的把关人角色。在此背景下，一款具备多种视觉和听诊检查功能的远程医疗设备被提供给了2000名参保远程医疗的客户。该设备能将诊断信息发送给医疗服务提供者并用于远程医疗咨询。为了确定多功能远程医疗检查设备的额外应用是否会使参保远程医疗的客户减少面对面问诊、降低服务利用率并减少医疗保健支出。我们的分析基于2019年和2020年在一个远程医疗呼叫中心模式下参保的135636名客户的理赔数据。我们将收到远程医疗设备的客户与未收到此类设备的客户的医疗保健使用情况和医疗保健成本进行比较，并使用多变量回归来调整因自我选择导致的组间差异。我们发现，使用远程医疗设备的客户的总医疗保健支出降低了229瑞士法郎，住院费用降低了160瑞士法郎。然而，远程医疗设备的应用并未导致服务利用率在统计上显著降低。当参保远程医疗的客户收到多功能远程医疗设备时，他们的治疗平均而言更具成本效益。因此，用能够改善远程医疗咨询的远程医疗设备补充现有的远程医疗模式，有可能提高现有远程医疗呼叫中心模式的成本节约潜力。
