Swedish telemedicine system is classified as the best telemedicine country in Europe, but it was pointed out that the use of medical services has increased only due to convenience rather than expanding accessibility to underserved areas. Some opinions have derived that there is a limit to applying Sweden’s telemedicine case to Korea.
The Research Institute for Healthcare Policy of Korean Medical Association (Director Ahn Deok-Seon) recently explained the current address of telemedicine in Sweden and its implications for Korea.
As COVID-19 has highlighted the need for virtual visits using telemedicine, many countries are trying to change their telemedicine policies. Korea has also abandoned its stance of banning telemedicine and allowed telephone for a medical consultation temporarily since February to prevent COVID-19 infection in medical institutions.
Among the European countries, Sweden, Denmark, Iceland, and Finland are considered the most advanced e-health countries to apply Information and Communication Technologies (ICT). Of these, Sweden has an excellent electronic prescription system and aims to become the world’s best e-health country by 2025.
Sweden has laid the foundation for e-health development as doctors can send about 95~100% of prescriptions remotely to pharmacists, and also secured legal bases on health care services, patient information and patient safety to implement telemedicine.
As a result, Sweden achieved national performance and development of comprehensive e-health as well as telemedicine with 6.5 million people (about 63.35% of Sweden’s population) accessing the national health portal, ‘Health-care Guide 1177’s e-service’, up 35% in accessibility to medical care than the previous year.
Electronic Expert Support, which helps pharmacists determine pharmaceutical-related issues, has steadily doubled over the past three years, and more than 99% of medical prescriptions have been done electronically.
In addition, all citizens can read their medical records through the national health portal, view prescription drugs and test results through the national health portal, and 95% of local governments are connected to aces medical records of different health care providers.
However, The Research Institute for Healthcare Policy has pointed out the side effects and cost problems of Swedish telemedicine.
The Research Institute for Healthcare Policy said, “Because of the overuse of medical service due to convenience, medical diagnosis cannot be done solely by telemedicine, and practical examination trough face-to-face consultation is essential,” and “The expansion of telemedicine risks doctors to reduce diagnostic tests and overprescribe drugs such as antibiotics. This may encourage the overuse of healthcare services.”
“We checked telemedicine usage in Sweden in 2016, and found that the most populous areas accounted for the majority of telemedicine use,” they said. “While the population share in Stockholm was about 23% as of 2017, 43% of all telemedicine occurred in Stockholm and was nearly twice as overused as the population share.”
The institute explains that this is an example of an increase in medical use caused by convenience rather than greater access to vulnerable areas.
“If you look at the age distribution of telemedicine users, it shows that the medical use between 0 and 4 is the highest, with the infant population was about 6% of Sweden’s population, accounting for about 20% of the telemedicine use, and this indicated an overused pattern,” they noted, “It can be interpreted that parents of young who have easy access to e-health have received diagnosis and prescription for their children through telemedicine.”
The research center continued, “On the other hand, the use of telemedicine by senior citizens aged 65 or older is low compared to the population share,” and said, “The increased accessibility and overuse of medical care of telemedicine will result in a huge increase in government subsidies to support the cost of primary medical visits, and there is a risk of unsustainable increases in costs for taxpayers.”
“If the actual number of visits to medical institutions does not decrease despite the adoption of telemedicine, and the cost of telemedicine increase, it can be said that deterioration of healthcare priorities and increase in additional medical visits have occurred,” and said, “Therefore, it is necessary to consider at the national level whether the increase in total national healthcare costs and deterioration of public finance might occur.”
They added, “Although Korea is in an environment where we can connect health and medical services with IT development, there is a limit to applying Swedish telemedicine cases,” and said, “Korea’s health insurance system and Sweden’s national health service differ in the healthcare system, and we lack in legal grounds and social consensus on the Medical and Patient Information Act for telemedicine.”
“Like Sweden cases, access to telemedicine can be increased at a certain age or class, resulting in asymmetrical overuse of healthcare and brings out an increase in national health care costs and a risk of worsening health insurance funds,” and added, “We need a careful review of telemedicine cases in other countries including Sweden.”