Lina Maria Ellegård, Gustav Kjellsson, Linn Mattisson
Abstract The emergence of markets for on-demand online physician consultations —direct-to-consumer telemedicine (DCT) — is currently transforming many healthcare settings. DCT may be a cost-effective substitute for in-person consultations, but the convenience of seeking DCT may increase the demand for the service and consequently also the costs for health insurers. To causally assess the degree to which DCT consultations substitute for in-person primary care consultations, we exploit exogenous changes in patient fees in a fuzzy difference-in-discontinuities analysis of young adults in Sweden. We estimate that 45% of DCT consultations replace in-person visits; the rest represents new utilisation. We further estimate that the increase in volume could be close to cost neutral, and we find no evidence that quality deteriorates due to the increased use of online care.