Telemedicine—the delivery of medical services through electronic means of communication—is potentially transformative, mitigating transportation problems, bringing care to rural communities and decreasing waiting times and medical costs. But its adoption in Latin America has been slow. Insufficient communication infrastructure and status quo biases, among other factors, have hampered its use. Regulation has not caught up. As of 2019, while 65% of hospitals in Chile were using telemedicine, less than 30% of hospitals in Argentina, Costa Rica, Mexico, Peru and Colombia were doing so.
The COVID-19 pandemic, however, was a shock to the system, making the virtues of telemedicine apparent. Argentina, among other countries, had long recognized telemedicine as pivotal in its strategy to ensure universal health coverage. After the onset of pandemic, it passed legislation to validate electronic prescriptions, and launched TeleCOVID, a public telemedicine service provider. By September 2020, the senate had approved a new bill that would regulate telemedicine going forward.
Consumers Respond to Telemedicine
Consumers also responded as mobility restrictions were introduced, as we reveal in a recent study of telemedicine during the COVID-19 crisis in Argentina, using data from Llamando al Doctor one of the main providers of telemedicine in the country. Those restrictions dramatically increased the use of telemedicine, particularly among certain age and health groups, and may have opened the way to a broader acceptance of telemedicine post-COVID. The impact of the restrictions surfaced the week of March 13. By March 15, 2020 the government had closed international borders and ordered schools to halt in-person classes. Five days later, it declared a total lockdown, resulting in a precipitous drop in mobility of all sorts. This can be seen in the figure below which uses data from various navigation software apps.
Figure 1: Change in Mobility in Argentina 2020 vs 2019
The use of telemedicine, meanwhile, increased dramatically as patients sought substitutes for in-person care. During the week of March 13, the total number of calls and the number of calls from first-time telemedicine users increased by 233% and 226% respectively and the number of calls resulting in prescriptions increased by 342%. As can be seen in Figure 2, this increase persisted during the subsequent months of lockdowns and even afterwards. Indeed, while telemedicine use declined slightly after restrictions were relaxed, it remained significantly higher than during the pre-pandemic period, indicating a potentially permanent shift towards acceptance of the innovative medical practice.
Figure 2: Estimated Weekly Changes in Telemedicine Demand
A Shifting Demographic
It was not only the numbers of new users that marked a difference. The characteristics of telemedicine users also shifted. As can be seen in Figure 3, while patients using telemedicine during 2019 had an average age of 30 without underlying health problems, the substantial increase in its use during the pandemic was driven by patients 65 or older and those with pre-existing conditions, as positive experiences appeared to overcome previous biases and behavioral restraints to using a more virtual form of treatment.
Figure 3: Heterogenous Effects
It is, of course, impossible to know for sure how durable these changes will be. Argentina, like much of Latin America, is still in the midst of the COVID-19 crisis with sustained social distancing measures. Moreover, we don’t have a proper control group, making past behavior the only available point of comparison. This complicated scenario leaves unanswered questions, particularly as to whether there have been other confounding factors that could have affected the demand for telemedicine during the pandemic.
Telemedicine’s Potential Payoffs in the Future
Still, our analysis seems to provide crucial insights into changes in healthcare use and uncover a previously hidden demand for telemedicine services with numerous potential payoffs for the future. Telemedicine during the pandemic has facilitated the screening of patients. It has helped to direct patients to the most suitable health provider, isolate those who might be infected by the virus, and increase the capacity of the health care system. If the increase in demand for telemedicine services persists, as we expect and hope, it could emerge long-term as a crucial tool for public health management that increases the accessibility of medical care and significantly reduces the travel time and costs in obtaining it.
Many kinks in the system will have to be worked out for this to happen and for telemedicine to become more of a reality in the region, including as a service traded across borders when the health care system in one or more country becomes overwhelmed. This includes the establishment of a more robust legal and regulatory framework as it relates to patient privacy, insurance and the licensing of practitioners. Nonetheless, one of the silver linings of the terrible COVID-19 tragedy may well be the widespread acceptance of a powerful new tool in healthcare and better patient outcomes, particularly among remote and underserved communities.