Behavioral Interventions to Boost Telemedicine

Medical care is a challenge in Argentina, which stretches across nearly 2.8 million square kilometers (1.08 million square miles) of Andean mountains, pampas, steppe and desert.

So it's no surprise that the country was one of the first adopters in Latin America of telemedicine. Twenty-six percent of the hospitals nationwide offered telemedicine services to their patients in 2019 with a massive increase in telemedicine consultations in both the public and private systems during the pandemic.

An Underused Service

Still, telemedicine remains vastly underutilized. As in most of Latin America, where geographic barriers, economic disparities and strained healthcare systems would seem to encourage the use of the innovative tool, it still has a long way to go to achieve its potential in Argentine healthcare.

That is unfortunate. Telemedicine, including video consultations, the use of in-home health monitoring devices, and mobile health applications, can bridge the gap between health care providers and patients, no matter the distance, and allow for lower cost treatments if serious behavioral obstacles to its adoption can be overcome.

Telemedicine is free in Argentina, either publicly provided for those in the public system or offered by private health insurance companies. But potential users must overcome their ignorance of how it works, their mistrust of its effectiveness, and the inconvenience of downloading and setting up the required technology. They must also overcome behavioral biases. These include present bias-undervaluing the future gains of having the service ready should they become sick-and optimism bias-the underestimation of the probability of negative events, including future illness.

Behavioral Interventions to Increase Telemedicine Use

In a recent study, we showed how essential informational and behavioral interventions could overcome those biases and hesitation. We demonstrated how the right interventions could move people towards a tool that can save them the lost time (and cost) in travelling to a health clinic and waiting for the appointment and save clinics the higher medical consultations fees and administrative and no-show costs associated with in-person visits.

Working with APSOT, a private health insurance company that serves the managerial staff of the Techint Group in Argentina, and with Llamando al Doctor (Call the Doctor), one of the main telemedicine providers in Argentina, we randomized a sample of nearly 3,500 households that had never used the service. To those in the treatment groups (about half of the sample), we sent periodic emails with information about the benefits of the company's telemedicine services and easy-to-follow guides for using the service, with calls to action and actionable steps for beginning to employ the telemedicine option. The other half of the sample did not receive the emails and represented the control group.

People in the treatment group, for example, got messages telling them that "Winter is coming! Download (the app) Call the Doctor" or "Someone in your family needs to see the doctor? Download (the app) Call the Doctor for them." They also got messages with the doctors' hours and availability for telemedicine appointments, and personal information about the doctors, including quotes from them. This not only ensured patients that they could choose from the same roster of doctors through telemedicine that they had with in-person visits, thus overcoming distrust that telemedicine might be inferior; it also generated personalization and familiarity. Critically, all emails included easy instructions for downloading and using the app.

After eight months, households assigned to the treatment were about six percentage points more likely to have used the telemedicine system at least once than those in the control group and the number of virtual consultations by the treatment group was six times larger than that of the control group-evidence that the information interventions could effectively change patients' behaviors and the status quo.

What Works in Information Campaigns

If the information campaign was successful in increasing telemedicine use, however, not all such campaigns will be. First, message campaigns must be tailored to an understanding of why people aren't using the service. In this case, highlighting the fact that patients could use the same doctors they usually saw was critical. Secondly, the timing of a campaign is important to deal with behavioral biases, like present and optimism biases. Launching a campaign to coincide with the biggest seasons for medical visits might, for example, provide a bigger boost. It is important to keep in mind that the method of communication matters for increasing take-up. And tweaks might be considered: Starting in-person medical attention with a triage done through telemedicine could be useful for increasing first usage and motivate moving to telemedicine later on. Telemedicine is here to stay in a world in which easy digital connection can overcome problems of cost, distance, and limited patient and doctor availability. It can also ensure greater inclusion, both in normal times and those of a crisis, like a pandemic. The challenge is in getting people to accept and readily use it. The tools of persuasion are there; we must learn to properly employ them.

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