Can telehealth reduce health care expenditure? A lesson from German health insurance data.

Abstract

This study analyzes a telemedical program for chronic heart failure in Germany with respect to economic and treatment indicators. The program entails a routine data-based preselection of the insured and specific treatment intensities for low- and high-risk patients. This study complements previous research by considering differentiated end points such as mortality and rehospitalization as well as ambulatory, outpatient, and medication costs to account for potential cost shifts. In addition, different time frames and regional characteristics are dealt with. A difference-in-differences approach accounts for potential self-selection into the voluntary program. Our results challenge the current paradigm of program-induced cost shifting between hospital and ambulatory care. Except for a short-term effect in the lower-risk group, the program is associated with raising hospital admission rates as well as higher costs in all categories, while mortality is significantly reduced. The findings are robust as to various sensitivity checks.