Abstract
Background: In 2023, Health Intervention and Technology Assessment Program Foundation
(HITAP Foundation) conducted a study on “Recommendations to support the development
of operation and M&E process for telemedicine programme based on lessons learned from
Thailand and the world” under the World Health Organization-Country Cooperation Strategy
(WHO-CCS). The study covered issues related to inputs and activities, specifically the
development and provision of telemedicine, divided into four main components: adoption,
implementation, adaptation, and determinants. It also encompassed issues related to
outputs, such as the quantity and trends in the use of telemedicine services over different
periods. Subsequently, in 2024, to ensure the ongoing support for the development o f
telemedicine services, our research expanded the scope to investigate financial inputs and
activities, such as reimbursement systems for services and unit costs. Additionally, this
current study addressed issues related to outcomes, such as user experiences and impact on
outpatient services. The research questions and the implementation of the research project
were informed by stakeholder consultations and approved by the Steering Committee of the
Convergence of Digital Health Platforms and Health Informa tion Systems (HIS)
Implementation in Thailand (under WHO-CCS).
Objectives: This study comprises three objectives: (1) to investigate the experiences of both
providers and users of telemedicine services regarding acceptance, satisfaction, accessibility,
and usability; (2) to examine the outcomes related to the utilisation of telemedicine services,
including impacts on traditional face-to-face outpatient services; and (3) to assess the
readiness of healthcare facilities to provide telemedicine services, including cost estimation
and the development of policy recommendations for the reimbursement of telemedicine
services.
Methodology: This study employed a mixed-methods research design, incorporating both
qualitative and quantitative studies. The scope of the research covered telemedicine services
for chronic diseases, with some sections focusing specifically on telemedicine services for
non-communicable diseases, mental health disorders, and speech therapy. Data were
collected from a scoping review, in-depth interviews and focus group discussions guided by
semi-structured questions, as well as administrative dataset from reimbursement systems
and healthcare facilities. Qualitative data analysis employed thematic analysis, while
quantitative data analysis utilised descriptive statistics, interrupted time series analysis, and
difference-in-difference estimation, along with unit cost analysis from the perspective of
healthcare providers using activity-based costing.
Results: The findings of this study, based on the experiences of both healthcare providers
and patients, both those who had and had not previously used telemedicine services,
revealed a shared recognition and appreciation of the benefits of such services. The
interviews reported the increased convenience for service users, improved accessibility to
healthcare services, especially for those with mobility issues or living in remote areas, and a
reduced risk of hospital-acquired infections and associated stress. Furthermore, a majority of
those who had prior experience with telemedicine expressed satisfaction with the service
and a willingness to continue using it. However, a notable proportion of participants
expressed concerns regarding the potential for reduced efficacy compared to in -person
consultations. Additionally, all participants identified barriers to accessing and utilising
telemedicine services, including limitations in device availability and internet connectivity,
the suitability of the service delivery channels, and a lack of technological proficiency among
service users.
An analysis of the reimbursement data from the National Health Security Office (NHSO)
covering the period from January 2021 to March 2024 revealed a total of 811,556
telemedicine services involving 426,366 users. The majority of users were female (61%), with
over 50% belonging to the elderly population. Notably, a significant proportion of users
(66%) had only utilised the service once, while 61% of those who returned for subsequent
consultations did so intermittently. The most common indication for telemedicine services
was essential (primary) hypertension (ICD-10 code: I10). Moreover, an analysis of the impact
of the Ministry of Public Health’s telemedicine policy implemented in 2023 indicated a trend
of increased telemedicine consultations; however, this increase was not statistically
significant (Odds Ratio (OR): 2.07, 95% Confidence Interval (CI): 0.91-4.68). Regarding the
impact of the policy on outpatient services, it was observed that the average number of
outpatient consultations decreased by approximately 3,000 visits per month per healthcare
facility.
As for the readiness and reimbursement for telemedicine services, it was found that only
21% of all public healthcare facilities had registered and passed the NHSO's assessment for
the Telehealth/Telemedicine programme (for chronic diseases), while merely 9% of these
facilities reimbursed for telemedicine services. In terms of unit cost estimation, most costs
were attributed to labour costs. The break-even price varied among healthcare facilities,
depending on the resources utilised and their service capabilities. Notably, the service model
in which patients require assistance from a hospital to access telemedicine incurred higher
costs than the model in which patients can receive services independently. When considering
total costs without deducting labour costs, it was observed that the break-even prices of all
sampled healthcare facilities exceeded the current reimbursement rates for telemedicine
services.
Conclusions: Telemedicine is being recognised as a valuable resource for the healthcare
system, both now and in the future. Continuous monitoring and evaluation of service
delivery are essential to support all stakeholders involved, including policymakers, service
providers, and patients, in enhancing acceptance, satisfaction, accessibility, and usability.
Furthermore, policymakers should engage in ongoing discussions regarding the target groups
for telemedicine services and ensure adequate resource allocation to support telemedicine,
particularly in infrastructure such as computers, internet access, and data management
systems. Ultimately, digital health will be a crucial component in strengthening the
healthcare system to achieve goals of efficiency, equity, and quality service delivery.
