Direct-to-Consumer Telemedicine Replaces About Half of In-Person Visits Among Young Adults, Study Finds

Direct-to-consumer telemedicine (DCT) consultations may partially substitute for in-person primary care visits among young adults, but they also generate additional demand for health services, according to a new analysis of health care utilization in Sweden. The study found that approximately 45% to 46% of online physician consultations replaced in-person visits, while the remaining encounters represented new utilization rather than substitution.¹

“People often seek online healthcare for simple ailments, a type of care for which price generally matters more,” study coauthor Gustav Kjellsson, a researcher in health economics at the University of Gothenburg, said in a press release. “This doesn’t necessarily mean that it is unwarranted care. It’s important to bear in mind that without access to medical expertise, it is difficult to determine which healthcare needs you actually have. Easing people’s worries also has a value.”²

The findings come from the study “An App Call a Day Keeps the Patient Away? Substitution of Online and In-Person Doctor Consultations Among Young Adults,” which analyzed administrative health care data from Swedish regions where telemedicine platforms rapidly expanded after 2016.¹

Evaluating substitution between telemedicine and clinic visits

The researchers used detailed administrative data covering physician consultations, diagnoses, and prescription records linked to demographic information for young adults in Sweden. The analysis leveraged a natural policy threshold: individuals begin paying user fees for online physician consultations when they turn 20 years old. This change in out-of-pocket cost created a measurable decline in telemedicine use that could be compared with changes in in-person care utilization.¹

Using a fuzzy difference-in-discontinuity design, the investigators estimated how reductions in telemedicine use after the fee introduction affected clinic visits. The results showed that the number of DCT consultations fell by about 0.15 visits per person annually—roughly a 50% decline—after the user fee began, while in-person visits increased modestly but did not fully offset the decline.¹

Taken together, the analysis indicated that about half of telemedicine consultations substituted for in-person visits, whereas the other half represented additional demand for medical consultations.¹

Additional visits often addressed minor conditions

Further analyses suggested that much of the increased utilization involved relatively minor conditions. A majority of additional consultations consisted of single encounters without follow-up, suggesting that easier access to online care lowered the threshold for seeking medical advice.¹

Many of these visits were related to conditions frequently managed in telemedicine settings, including respiratory infections, dermatologic concerns, and reproductive health issues. For respiratory infections in particular, the study found the highest degree of substitution, with online visits often replacing clinic consultations.¹

In contrast, telemedicine visits related to skin conditions or reproductive health showed weaker substitution effects, possibly reflecting differences in care pathways or the availability of non-physician clinicians such as nurses or midwives for these conditions.¹

No evidence of reduced care quality

Despite the increase in overall consultation volume, the investigators found no evidence that expanded telemedicine access worsened care quality. Measures of low-value prescribing—such as unnecessary antibiotics or medications with strict prescribing guidelines—did not increase with greater telemedicine use.¹

The study also found no increase in complications or hospitalizations associated with conditions commonly treated through telemedicine, although the estimates for rare events were imprecise.¹

In addition, the analysis suggested that easier access to telemedicine may encourage care-seeking for certain sensitive conditions, particularly sexual health concerns among men.¹

Implications for health systems

Telemedicine’s rapid growth has prompted debate about whether virtual care reduces costs by replacing in-person visits or increases spending by stimulating new demand. The Swedish findings suggest that both mechanisms occur simultaneously.¹

Although telemedicine generated additional consultations, the authors estimated that the lower cost of producing online visits may make the overall effect close to cost-neutral, particularly when compared with the higher cost of clinic-based visits.¹

The authors concluded that telemedicine can expand access to care without evidence of reduced quality, but policymakers should consider the balance between substitution and new utilization when designing reimbursement policies and patient cost-sharing structures.¹

References:

1. Ellegard LM, Kjellsson G, Mattisson L. An app call a day keeps the patient away? Substitution of online and in-person doctor consultations among young adults. The Economic Journal. Published online January 29, 2026. doi:10.1093/ej/ueag016
2. Online doctors – popular but price-sensitive for young people. University of Gothenburg. News release. March 4, 2026. Accessed March 9, 2026. https://www.eurekalert.org/news-releases/1118659