Department of Health Policy, London School of Economics and Political Science, United Kingdom.
Department of Health Services, Policy, and Practice, School of Public Health, Brown University, United Kingdom.
Soc Sci Med. 2024 Aug;354:116570. doi: 10.1016/j.socscimed.2024.116570. Epub 2024 Jan 8.
In low- and middle-income countries, many believe that telehealth services could significantly expand access to doctors by offering remote access at low cost. Yet, despite its convenience, telehealth care is limited by the absence of physical examination, point-of-care testing, or immediate treatment. Hence it is unclear how individuals value such options compared to standard face-to-face care. We study this issue in South Africa with general practitioners who today mostly practice in the private sector and are geographically located in wealthier areas with higher health insurance coverage. We use an incentive-compatible method to elicit robust measures of willingness-to-pay (WTP) for telehealth and face-to-face consultations with general practitioners in a sample of uninsured individuals. We find that only 36% of respondents are willing to pay the prevailing market price for a telehealth consultation. We find average WTP for in-person consultations is only 10% higher than that of telehealth. Additionally, individuals with higher health needs are willing to pay a premium for face-to-face consultations, while others are indifferent. Our findings suggest that private telehealth services are better suited for more minor health needs, but are unlikely to expand access to a majority unless cheaper models are introduced.
在中低收入国家，许多人认为远程医疗服务可以通过提供低成本的远程访问来显著扩大医生的服务范围。然而，尽管远程医疗很方便，但它受到缺乏体检、即时护理测试或即时治疗的限制。因此，与标准的面对面护理相比，人们对这种选择的重视程度尚不清楚。我们在南非的全科医生中研究了这个问题，这些医生目前主要在私营部门工作，地理位置在医疗保险覆盖率较高、更富裕的地区。我们使用一种激励相容的方法，从无保险的个体样本中得出对远程医疗和全科医生面对面咨询的支付意愿（WTP）的有力衡量标准。我们发现只有 36%的受访者愿意支付远程医疗咨询的现行市场价格。我们发现，面对面咨询的平均 WTP 仅比远程医疗高 10%。此外，健康需求较高的个体愿意为面对面咨询支付溢价，而其他人则无所谓。我们的研究结果表明，私人远程医疗服务更适合于较小的健康需求，但除非引入更便宜的模式，否则不太可能扩大对大多数人的服务范围。
