Viet Nguyen, Mika Kortelainen
Abstract
This review synthesizes evidence from thirteen quasi-experimental studies that evaluate the impact of telemedicine on primary care utilization, spending, and health outcomes across multiple countries. These studies span both pre-pandemic implementation and the accelerated adoption of remote care during COVID-19. Of these, five were classified as Tier 1, indicating a low risk of bias. Across studies, remote consultations most often complement rather than substitute for in person visits, potentially contributing to higher overall utilization, particularly among new and low frequency users. Evidence of substitution is limited and largely confined to specific contexts, such as mental health services or periods of restricted physical access during the pandemic. Health outcomes are generally comparable to in-person care, with emerging but still limited evidence of improvements in chronic disease management and mental health. Evidence on spending remains heterogeneous: costs tend to rise when telemedicine adds low acuity visits and follow up, but may be neutral or slightly lower when it replaces higher cost care.
Keywords: primary healthcare, telemedicine, effect, determinant, quasi-experiment