Abstract
Background: Telemedicine (interconsultation between primary and hospital care teams) has been operating in the counties of Central Catalonia Bages, Moianès and Berguedà since 2011, specializing in teledermatology, teleulcers, teleophthalmology and teleaudiometries. For the period until the end of 2019, a total of 52,198 visits were recorded. Objective: To analyze the differential costs between telemedicine and usual care in a semi-urban environment. Methodology: A cost-minimization evaluation, including direct and indirect costs from a societal perspective, distinguishing healthcare and user’s costs, was carried out over a three-month period. Results: Telemedicine saved € 780,397 over the period analyzed. A differential cost favorable to telemedicine of about € 15 per visit was observed, with the patient being the largest beneficiary of this saving (by 85%) in terms of shorter waiting times and travel costs. From the healthcare system perspective, moving the time spent in a hospital care consultation to primary care is efficient in terms of the total time devoted per patient. In social terms and in this context, telemedicine is more efficient than usual care. Conclusion: Allowing users to save time in terms of consultation and travel is the main driver of interconsultation between primary and hospital care savings in a semi-urban context. The telemedicine service is also economically favorable for the healthcare system, enabling it to provide a more agile service, which also benefits healthcare professionals.
Highlights
This study case includes four telemedicine specialties which are currently conducted in the Catalan public healthcare system, Central Catalonia Health Region
Despite the fact that 21% result in a face-to-face visit, and that the salary per hour is higher in the context of primary care than in hospital care, the consultation time of 79% of cases was reduced by 8 minutes, implying savings in relation to usual care, where all visits are face to face and 15 minutes, for a professional time equivalent to € 154, 542 for the sample under analysis
The study concludes that, in the given context, telemedicine is an unequivocally preferable option to usual care from an economic point of view. The strength of this diagnosis is similar to that derived from the analysis performed with 2016 data for the specific case of teledermatology, i.e., the result of including other specialties, lengthening the time period and adding the indirect cost approach of the caregiver results in savings per visit 35% above the base case studied by Vidal Alaball et al with 2016 data [12] (Table 6)
Summary
In Catalonia, the integration of the health information systems between primary care and specialized care allows for a fluid telemedicine-based case management. This implies relatively low coordination costs among different health specialties and incentivizes the use of these tools by health providers. The availability of information on healthcare activities provides an excellent opportunity to evaluate their impacts To this end, this study case includes four telemedicine specialties (teledermatology, teleulcers, teleophthalmology and teleaudiometries) which are currently conducted in the Catalan public healthcare system, Central Catalonia Health Region. The telemedicine service is economically favorable for the healthcare system, enabling it to provide a more agile service, which benefits healthcare professionals
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