In today’s hybrid world, service providers face important choices about how to deliver one-on-one services like financial advice, tutoring, and healthcare. Should these services be offered online or in person, and to whom?
While online services promise lower costs and greater convenience, interactions over a screen can differ from face-to-face meetings in ways that may impact service quality and outcomes. Yet, despite the growth of online services, there is still little direct evidence comparing online and in-person experiences. Understanding these trade-offs can help decision-makers make more informed choices.
Improving efficiency
This issue is especially critical in healthcare. Both public and private healthcare providers, as well as insurers, see the shift online as a way to improve efficiency—a pressing need given rising costs in aging societies. For patients, online healthcare offers the benefits of convenience, faster access, time savings, reduced infection risk, and greater equity between urban and rural areas. A key focus in this shift is the patient’s consultation with primary care physicians (GPs), which increasingly takes place online.
Researchers at the London School of Economics recently studied how switching doctor consultations from in-person to online affects patient outcomes and provider costs. Their analysis used data from Sweden, where national health insurance covers both public and private providers.
The data came from Europe’s largest digital healthcare company, which since 2019 has offered patients comprehensive primary care, including both in-person and online consultations. The researchers matched this data with anonymized patient information on demographics, socioeconomic status, and health outcomes.
Fair comparison
One challenge in comparing online and in-person consultations is that patients rarely experience both. The researchers focused on cases where patients were directed to either online or in-person consultations by nurses when no doctors were immediately available. This allowed them to compare outcomes for patients with similar needs who were triaged differently.
Another challenge is that nurses may direct sicker patients to in-person consultations. The researchers addressed this by analyzing each nurse’s previous patterns in directing patients to either online or in-person care, mimicking a random assignment of patients between the two formats.
The study found that while online consultations do save money for providers, the savings are less than they first appear—largely because sicker patients are often sent to in-person appointments. Online consultations tend to be quicker and happen sooner than in-person visits, but doctors spend less time interacting with the patient and more time afterward on administrative tasks. The quality of care, however, remains similar: diagnosis, prescriptions, referrals, and patient satisfaction are largely comparable between formats.
Broader outcomes
The researchers also looked at broader health outcomes, including hospital admissions, emergency department visits, and follow-up appointments. Online consultations did not significantly affect preventable hospitalizations but were linked to an increase in overall hospital admissions, emergency visits, and follow-up consultations within 30 days. These effects, however, disappeared in the medium term.
On the whole, the study suggests that while online consultations provide some cost savings without compromising long-term patient outcomes, the increase in follow-up visits reduces these savings from an initial estimate of 75% to just 20%. For patients, the time and convenience benefits of online care often outweigh the cost savings.
The higher follow-up rate may be due to two factors: sicker patients tend to be triaged to consultations in the first place, and the sample included mostly urban patients who can more easily attend follow-ups. Therefore, the average Swedish patient could see greater benefits from online consultations than what was observed in this study.
Different markets
The study also revealed that while many patients view online consultations as a replacement for in-person visits, older people and immigrants are more skeptical. This suggests that online consultations may be better suited for healthier, less vulnerable patients.
Indeed, those with more complex health issues are more likely to need further care after an online consultation. Directing these patients to in-person visits while keeping online care for healthier patients could lead to better outcomes and savings for both providers and patients.
In sum, the research offers valuable insights into the pros and cons of online versus in-person care. As more organizations adopt hybrid models of service delivery, understanding these dynamics will be essential for making effective decisions that balance costs and outcomes.
