Telehealth will play an important and increasing role in a post-pandemic Europe

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People wearing masks during COVID-19 Europe

Telehealth is unlikely to become a substitute for face-to-face healthcare services in a post-pandemic Europe, but it will continue to play an important and increasing role, according to the OECD’s latest edition of Health at a Glance: Europe 2020.

The OECD report, which was released in November 2020 and provides a snapshot of the current health situation in Europe, anticipates that when countries ease lockdown restrictions, and healthcare facilities open their doors again to patients, the number of telehealth consultations is likely to decrease, as has happened in the United States.

However, longer term, the report predicts that telehealth will play an increasingly important role in the delivery of health services.

According to the report, the pandemic has shown that European countries can move quickly to break down barriers to telehealth and other digital tools; although some barriers are structural and less amenable to short-term regulatory changes, for example, access to broadband, medical liability across jurisdictions, cybersecurity, and data protection.

What is clear, says the report, the pandemic has led to an unprecedented adoption and use of telehealth that would not have otherwise happened so quickly.

Telemedicine – preserving continuity of care and containing the spread of COVID-19

Released every two years, Health at a Glance: Europe 2020 is a result of collaboration between the OECD and the European Commission. The document compares key indicators for population health and health-system performance across 28 European Union member states, five candidate countries, and three European Free Trade Association (EFTA) countries.

The report highlights how these countries differ in terms of the health status and health-seeking behaviour of their citizens; access to and quality of healthcare; and the resources available for health.

Not surprisingly, this year’s report focuses on the impact of the COVID-19 crisis.

Before the pandemic, says the report, the adoption of telehealth and telemedicine was limited in Europe, with providers and patients facing barriers to wider use.

However, with rising cases and lockdowns limiting face-to-face care, countries moved at speed and at scale to remotely deliver a range of digital services.

Countries such as Austria, Belgium, Estonia and the Czech Republic that did not have national legislation, strategy or policy on the use of telemedicine, and did not define jurisdiction, liability or reimbursement of services like telehealth, have since allowed provider payment for some telehealth consultations and clarified regulations.

Countries where telemedicine was already allowed before the pandemic, like France, Luxembourg and Poland, have made it easier for providers and patients to use remote consultations by relaxing restrictions or by creating new platforms.

For example, in Poland, new COVID-19 platforms combined with existing digital services such as the Patient’s Online Account Platform, making it possible to conduct around 80 percent of consultations remotely during the first wave of the pandemic.

Since COVID-19, Belgium, Estonia, Greece and Ireland have allowed prescriptions and certificates of sick leave to be issued and accessed electronically.

The use of telemedicine has increased substantially in some European countries.
  • In France, there were close to 500,000 telehealth consultations between 23-29 March, as compared to around 10,000 teleconsultations per week before March.
  • In Germany, an estimated 19,500 teleconsultations were performed in March, compared to 1,700 telehealth consultations per month in January and February. In Norway, the share of e-consultations with a GP rose from five percent between 2-8 March to almost 60 percent between 16-22 March.
  • At least 11 European countries have helplines dedicated to COVID-19, including needs triggered by the lockdown, with an emphasis on mental health and emotional support.
  • Denmark, Portugal, Spain, the United Kingdom and WHO/Europe among others have also used AI-powered interactive chatbots to deal with the surge in service demand, and to collect information on symptoms, to triage patients, and to combat misinformation.
  • Even before the crisis, many European countries were already using telehealth monitoring for chronic patients, and these programmes have acquired a new impetus, with many patients unable to attend face-to-face routine appointments.
  • While it is unclear how much medical care can be provided remotely through digital means, telehealth is unlikely to be a substitute for the majority of health care services. Still, says the report, it can play an important and increasing role. For example, a recent US study estimated that 20 percent of all Medicare spending could be virtualised (McKinsey, 2020).
Other highlights from Health at a Glance: Europe 2020 include:
  • Some European countries have used digital technologies to maintain essential clinical and social care to long-term-care (LTC) recipients, as well as to limit social isolation by facilitating virtual contact with families. Countries that expanded their telehealth services in LTC during the first wave of the pandemic include Austria, Belgium, Czech Republic, Estonia, Finland, France, Greece, Ireland, Luxembourg, Poland, Portugal, Slovak Republic, Switzerland and the United Kingdom.

List of European countries that have expanded into Telehealth since COVID

  • In England, social-care and healthcare workers have been connecting using dedicated digital tools, and residents in LTC facilities have the option of teleconsultations. Germany, Austria and Italy have also promoted the provision of care remotely through digital means.
  • While telehealth cannot replace all needed care, telemedicine and smartphone-based assessments have helped Europe with remote monitoring and care for people with dementia or other cognitive impairments.
  • In palliative care, Austria, France, Italy and Spain provided guidelines on symptom management in a time of more limited capacity, and ways to help patients maintain virtual contact with families.
  • The key to maintaining continuity of care for non-COVID-19 patients includes maintaining primary healthcare practices, establishing community care facilities, extending home-based programmes, expanding the role of primary healthcare workers and increasing telemedicine consultations. These factors are key to minimise delays and forgone care for all patients.

Graph showing reduction in the volume of primary care consultations during the first wave of COVID

  • COVID-19 has seen acute- and chronic-care patients face disruptions to essential care, in terms of delayed diagnoses, foregone care and impeded continuity of care.
  • Many countries postponed elective surgery to free up human resources and hospital beds and there have also been fewer visits to emergency departments. France has also reported fewer specialist care appointments.
  • Disruptions to cancer diagnosis and treatment are evident and will impact patient survival rates. In England, delays in diagnoses have been estimated to increase cancer deaths by about 16 percent for colorectal cancer, nine percent for breast cancer, six percent for oesophageal cancer, and five percent for lung cancer over the next five years. In France, delayed diagnoses could lead to an excess mortality of 10-15 percent per month of delay.
  • Mobilising community pharmacists helps ensure patients continue to get needed medicines. Some countries have also enhanced the role of community health workers. For example, the United Kingdom proposed training community health workers to manage long-term conditions and review medicine use for elderly people and those with underlying health conditions.
  • The COVID-19 crisis has had a marked impact on mental health. Many countries have provided wellbeing support to the general population, for example through online advice or phone hotlines.

Graph showing share of population experiencing anxiety pre-COVID

  • Support services for mental health and wellbeing of doctors, nurses and other hospital workers were expanded by many countries to help them deal with the high level of stress, fatigue, and psychological distress during these extremely challenging times, for example through peer-support groups or dedicated phone-support lines.

You can read the full version of the OECD report, Health at a Glance: Europe 2020 here.

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