Higher Costs Prompt Patients to Switch From Telehealth to In-Person Care

Patients who preferred telehealth visits were more sensitive to out-of-pocket cost than those who preferred in-person visits, according to a new study by the RAND Corporation, a nonprofit research organization.

Published in JAMA Network Open, the study aims to assess patient preferences for video visits once the COVID-19 pandemic has ended and to identify the role of out-of-pocket cost in changing the patient preference for virtual versus in-person care.

Researchers gathered data from the American Life Panel Omnibus Survey, conducted between March 8 and March 19. A total of 2,080 RAND American Life Panel members completed the survey.

About 45 percent of participants reported having had one or more video visits with healthcare providers since March 2020. Only 2.3 percent among them reported that they were unwilling to use it again in the future.

When out-of-pocket costs were not a factor in the decision to seek care, most (53 percent) of the respondents said they preferred an in-person visit, 20.9 percent preferred a video visit, and 26.2 percent did not have a preference or did not know.

Having had a video visit in the past influenced patient preferences. Of those respondents who had participated in a video visit since March 2020, 31.4 percent preferred a video visit. On the other hand, of those without any prior telehealth experience, only 12.2 percent preferred a video visit versus 60.2 percent who wanted an in-person visit.

The study also shows that out-of-pocket costs had a noticeable effect on patient preference for visit modality.

Those who preferred in-person care when cost was not considered were provided with a scenario in which the cost of an in-person visit was $30, while a video visit was only $10.

Nearly half (49.8 percent) still preferred an in-person visit, while 23.5 percent switched and said they now preferred a video visit.

When the situation was reversed and those participants who preferred video visits when cost was not a factor were faced with the scenario of a more expensive video visit ($30) compared to a less costly in-person visit ($10), only 18.9 percent still preferred a video visit. About 61.7 percent switched and said they would rather have an in-person visit.

"Patients may like telehealth in certain circumstances such as when they need care for minor health issues," said Zachary S. Predmore, PhD, the study's lead author and an associate policy researcher at RAND, in a news release. "But their willingness to use telehealth is very sensitive to costs. Patients may not perceive video visits to have the same value as in-person healthcare."

Study authors elaborated on the potential reasons for the difference in perceived value of each type of visit. Patients may like telehealth only for certain minor conditions as they may not believe that clinicians are able to offer an equivalent service or are putting in as much clinical effort in a telehealth visit as compared with an in-person visit.

"Alternatively, some patients may perceive benefits to in-person care that even the highest quality telehealth visit cannot replicate (eg, rapport with clinician as well as ritual and structure of coming in person), outweighing the additional costs associated with in-person care (eg, travel and time costs)," the authors wrote.

But despite this difference in value perception, 66.5 percent wanted at least some medical care offered via video visits after the COVID-19 pandemic. As a result, it is important that providers glean insights from patient preferences as they design care delivery moving forward.

"Improving the delivery of telehealth is important, but that is only part of the story," Predmore said. "Being aware of patient preferences will help to identify the best role for telehealth in post-pandemic healthcare delivery."