Telemedicine public reimbursement models for national and subnational jurisdictions: a scoping review and stakeholder interviews (Preprint)

Background: Telemedicine has transformed healthcare delivery, offering improved access, efficiency, and potentially cost-effectiveness. However, wide-scale implementation is challenged due to multiple factors. Among these, reimbursements were reported to influence the scalability and sustainability of telemedicine.

Objective: This study seeks to understand current payment models and reimbursement considerations in national and subnational jurisdictions to inform policy development

Methods: A scoping review was conducted following Arksey & O’Malley’s six-stage framework and searched six databases using keywords related to telemedicine and reimbursement. We expected limited results from low- and middle-income countries and Asian countries, and therefore, we conducted key informant interviews to supplement the review and provide additional perspectives on reimbursement policies.

Results: A total of 31 sources were included, primarily published after 2020 and mainly discussed reimbursement in the United States. Five key informants agreed to participate in the interviews and provided telemedicine reimbursement policies in Canada, India, Nepal, Taiwan, and the United States. Payment methods varied widely and included fee-for-service, capitation, bundled payment, and value-based models. Considerations for reimbursement included the purpose of telemedicine, health, and non-health conditions (e.g., residential area), service providers, interaction method (e.g., real-time interaction, recorded), and the technology employed.

Conclusions: Different payment models come with unique advantages and challenges that should be carefully considered and managed. In designing a telemedicine reimbursement model, policymakers should consider their healthcare system's capacity and the specific needs of their populations while maintaining a balance between provider incentives. Adopting payment parity to in-person reimbursement rates may significantly encourage the adoption of telemedicine. This study assists policymakers in understanding relevant components of telemedicine reimbursement globally, enabling them to develop policies tailored to their healthcare context and ensuring equitable access alongside the long-term sustainability of telemedicine.