News article
From doctor’s appointment to screen consultation
With video calls and chat consultations, digital healthcare has in recent years become a natural part of medical services. But what does this development mean for equity, costs, and quality? New research offers a nuanced picture of the opportunities and challenges of digital healthcare.
What does the development of digital care mean for equity, costs, and quality?
The pandemic acted as a catalyst for digital healthcare, particularly within primary care, as many patients avoided in-person visits and healthcare services became less accessible.
"Digital healthcare then became an important alternative," notes Clas Rehnberg, Professor in health economics at Karolinska Institutet and leader of a recently concluded research project on the effects of digitalised care on health care utilisation, costs, and distribution of care services, funded by Forte.
Although the use of digital healthcare declined somewhat after the pandemic, it still remains far higher than pre-pandemic levels. Digital care has been promoted as a solution to improve accessibility, particularly in rural areas. But according to Clas, the reality is not quite so simple:
"There was an expectation that this would mainly benefit rural areas, but it’s actually in urban areas where digital healthcare is most heavily used, measured per capita."
He believes this can be attributed to both marketing and information dissemination.
"One would otherwise think that patients facing travel and time costs would be more interested than those in cities with easy access to care."
It was generally believed that this would mainly benefit rural areas, but it is in urban areas that digital healthcare is most widely used.
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Clas Rehnberg
Professor in health economics at Karolinska Institutet
The risk of unequal access with digital primary care
Another challenge is that digital primary care is most often used by younger, tech-savvy individuals with higher education and income.
"Traditionally, primary care has been more frequently used by low-income groups, which is seen as positive since ill-health is more prevalent among people with lower income or education. If primary care loses that low-income profile, it could lead to more unequal access to healthcare," Clas explains.
While digital healthcare can relieve pressure on health centres and hospitals, increased accessibility has also created the opposite effect: higher healthcare consumption.
"The threshold to seek care is lowered – patients may consult for issues they wouldn’t have otherwise, and digital services have often been more accessible than in-person care."
The reimbursement system plays a critical role, Clas adds. Digital care providers are paid per consultation, creating incentives to maximise the number of appointments.
Traditional providers are funded via a system known as capitation – a fixed amount per registered patient – and therefore do not have the same incentive to increase visit numbers by improving accessibility.
"Even though there is a relieving effect, the net outcome of digital care is still a certain degree of overconsumption," says Clas.
However, preliminary data shows that in terms of prescribing medication during digital consultations, Swedish providers have been cautious – especially with antibiotics.
"I think that can be explained by Sweden’s strict control systems," says Clas.
Digital care reaches new patient groups
Another dimension of digital healthcare is its potential to reach new patient groups suffering from mental health issues – individuals who might not seek help through traditional health centres. But resource allocation and prioritisation have been questioned in both media and interviews with primary care staff in another research project.
"There’s a concern that more resources are going to less severe cases suitable for digital services, while less time is spent on patients in need of more complex support," says Maria Hägglund, Associate Professor of health informatics at Uppsala University.
For patients with social anxiety or severe anxiety disorders, digital services may lower the threshold for seeking help.
"Digital healthcare can be an important piece of the puzzle, especially for young people with mental health issues. But in some cases, face-to-face meetings are part of the therapy itself," she adds.
We need to ask ourselves how to create equitable healthcare and how to connect the right patients with the right healthcare professionals.
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Maria Hägglund
Associate Professor of health informatics at Uppsala University
As with mental health, the relationship between patient and provider is often central to treatment effectiveness across various types of care. In the Forte-funded project ConnectMe, which Maria leads, researchers are investigating how video consultations affect staff working environments in different care contexts, as well as patient experiences. The researchers can already see ongoing adaptation efforts to find the most effective working models in various health care settings.
"Digital healthcare providers have structures optimised for video calls, whereas traditional providers often see digital care as an add-on that’s more difficult to manage. This raises questions: How do we handle digital patients waiting when a physical appointment runs over time? How do we ensure that digital care is just as safe for patients?" says Maria.
Creating equitable healthcare is a major challenge
In the ongoing project, researchers will ask staff how well they feel patients' needs are being met.
Earlier studies based on patient interviews have shown mixed views. Some patients value quick assistance and reduced travel, while others prioritise continuity and in-person visits with their care provider.
"We need to ask ourselves how to create equitable care and how to match the right patients with the right healthcare professionals, as people value these aspects differently," says Maria.
For digital care to reach its full potential, better integration with traditional healthcare is required, Maria believes. She sees great promise in integrating self-care tools and patient-led monitoring, where individuals can measure their own health metrics – but stresses the importance of careful implementation.
"This places high demands on how we develop and introduce digital services, so we create a well-functioning digital work environment with smooth information flow."
A poorly planned transition could increase cognitive load on healthcare staff, she warns.
Clas Rehnberg also emphasises that organisational challenges are central to the future of digital healthcare.
"The technology is there – but making it work within the structures and goals of the healthcare system is the real challenge."
Johanna Aggestam (English translation by Forte)
