The Medium Matters: Medical Decision-Making in Telemedicine versus In-person Care

The use of telemedicine has been on the rise. Although telemedicine has increased access to health care, little is known about how the medium changes providers’ medical decision-making. To evaluate how telemedicine differs from in-person care, we compare the quality and cost of in-person clinic visits and virtual visits over the phone for common conditions in Rwanda. To control for patient selection, we conduct an audit study with 2,532 standardized patient visits, where individuals portraying real patients presented standardized cases for malaria and upper respiratory infection (URI). We find that the quality of virtual care is higher than that of in-person care for URI and equally as good for malaria. Telemedicine providers also asked more questions about symptoms and medical history and prescribed more optional medicines for symptom management than in-person providers. We further find that telemedicine is more efficient than in-person care: virtual consultations were faster, had shorter wait times, resulted in fewer unnecessary medications and tests, and cost less for patients. Controlling for a rich set of provider characteristics, we show that provider selection does not appear to drive the results. Instead, better provider-patient communication over the phone emerges as a key mechanism. Providers report that it is easier to treat, get information from, and relate to patients over the phone. Providers also report feeling less social pressure during phone consultations. Consistent with survey evidence, we find that providers prescribe unnecessary antibiotics when asked by patients face-to-face, but not over the phone.