Payment Systems for Telemedicine: Comparative Study (Preprint)

BACKGROUND Many researchers have addressed the lack of reimbursement for telemedicine as one of the most important barriers to telemedicine adoption. However, little is known on how telemedicine should be implemented in reimbursement policy, how it must be financed, and what the right incentives are for an effective and efficient telemedicine use. OBJECTIVE To help future researchers to provide reimbursement policy recommendations, and to facilitate reimbursement decision-making, this paper analyzed and compared the telemedicine payment models of ten countries. METHODS A convenience sample was created of Western countries inside and outside Europe that already reimburse to some extent telemedicine. Ten countries met this criterion: Australia, Belgium, Denmark, France, Germany, Luxembourg, the Netherlands, Canada (Ontario province), Switzerland, and the United Kingdom. The study was based on the countries’ official physician fee schedules, listing all reimbursed medical services performed by physicians, including telemedicine. Based on the fee schedules, a comparative analysis of the payment models of telemedicine was conducted. RESULTS Televisits are reimbursed in all countries, which is not the case for telemonitoring and tele-expertise services. Telemonitoring is often restricted for patients with implanted cardiac devices. Telemedicine services are mainly paid fee-for-service, except for the telemonitoring of patients with implanted cardiac devices, which is paid through an episodic payment system in Australia. Payment parity exists across televisits and visits in person in France, Luxembourg, the Netherlands, and Switzerland, meaning that an equal fee is given for both services. CONCLUSIONS Our findings show that fees for telemedicine are lacking, especially for telemonitoring and tele-expertise. As telemedicine might enlarge disparities in healthcare access, policymakers should consider payment parity across televisits and face-to-face visits, and across telephone and video visits. Furthermore, an episodic physician payment system complemented with bonuses for quality outcomes, should be considered by policymakers for telemonitoring as it might capture the specificities of telemonitoring better than a fee-for-service system. Future research is needed on payment models, including research linking cost-effectiveness analyses with analyses on payment models, to allow profound reimbursement recommendations and a faster decision-making process for the reimbursement of telemedicine.

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