An App Call a Day Keeps the Patient Away? Substitution of Online and In-Person Doctor Consultations Among Young Adults
利用瑞典年轻人患者费用的外生变化，通过模糊断点回归分析发现，45%的在线问诊替代了面对面就诊，其余为新增需求，且质量未下降。
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.