每天一个应用能远离医生吗? 年轻成年人线上与线下医生咨询的替代
An App Call a Day Keeps the Patient Away? Substitution of Online and In-Person Doctor Consultations Among Young Adults
The Economic Journal · 2026 · [{"name": "Lina Maria Ellegård", "affiliation": ["Kristianstad University"]}, {"name": "Gustav Kjellsson", "affiliation": ["University of Gothenburg"]}, {"name": "Linn Mattisson", "affiliation": ["Lund University"]}]
中文摘要
摘要 按需在线医生咨询市场——即直接面向消费者的远程医疗（direct-to-consumer telemedicine, DCT）——正在改变许多医疗保健情境。DCT 可能是面对面咨询的一种具有成本效益的替代方式, 但寻求 DCT 的便利性可能增加对该服务的需求, 从而也增加健康保险机构的成本。为因果性地评估 DCT 咨询在多大程度上替代面对面初级保健咨询, 我们利用瑞典年轻成年人患者费用的外生变化, 进行了一项模糊断点双重差分（fuzzy difference-in-discontinuities）分析。我们估计, 45% 的 DCT 咨询替代了面对面就诊, 其余部分则代表新增的使用。我们进一步估计, 咨询量的增加可能接近成本中性, 并且没有发现证据表明在线医疗使用的增加会导致质量下降。
Abstract
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.