An App Call a Day Keeps the Patient Away? Substitution of Online and In-Person Doctor Consultations Among Young Adults
The Economic Journal · 2026 · Lina Maria Ellegård、Gustav Kjellsson、Linn Mattisson
中文摘要
按需在线医生问诊市场——即直接面向消费者的远程医疗（DCT）——的兴起，正在改变诸多医疗服务场景。DCT可能是面对面就诊的一种具有成本效益的替代方式，但DCT问诊的便利性可能会增加对该服务的需求，进而也增加医疗保险机构的成本。为因果评估DCT问诊在多大程度上替代了面对面的基层医疗就诊，我们利用瑞典青年患者费用的外生变化，对模糊双重断点差分（fuzzy difference-in-discontinuities）进行分析。我们估计，45%的DCT问诊替代了面对面就诊，其余部分则属于新增的医疗服务利用。我们进一步估计，服务量的增加可能接近成本中性，且没有发现证据表明在线医疗使用增加导致医疗服务质量下降。
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.