Short answer

When designing healthcare services, consider the potential for new digital offerings to substitute for existing in-person services, rather than solely adding to demand, and focus on seamless integration.

Field
Commercial Production
Source
The Economic Journal (2026)
Method
Fuzzy difference-in-discontinuities analysis
Evidence
Strong effect

Direct-to-consumer telemedicine (DCT) services are increasingly substituting for traditional in-person doctor consultations, with a significant portion of these online visits replacing rather than adding to overall healthcare utilization. This commercial production research insight is drawn from a 2026 study published in The Economic Journal. Using Fuzzy difference-in-discontinuities analysis, researchers explored how this design variable affects real-world outcomes. The key design takeaway: When designing healthcare services, consider the potential for new digital offerings to substitute for existing in-person services, rather than solely adding to demand, and focus on seamless integration.

Study
Commercial ProductionNew This WeekStrong effect

Direct-to-Consumer Telemedicine Substitutes for 45% of In-Person Doctor Visits

Direct-to-consumer telemedicine (DCT) services are increasingly substituting for traditional in-person doctor consultations, with a significant portion of these online visits replacing rather than adding to overall healthcare utilization.

The Economic Journal · 2026

01

Key Findings

  • 0145% of direct-to-consumer telemedicine consultations replace in-person visits.
  • 02The remaining 55% of DCT consultations represent new utilization, not replacements.
  • 03The increase in volume due to DCT may be close to cost-neutral.
  • 04There is no evidence that the quality of care deteriorates with increased use of online consultations.
02

Application

Design takeaway

When designing healthcare services, consider the potential for new digital offerings to substitute for existing in-person services, rather than solely adding to demand, and focus on seamless integration.

How to apply

When developing or refining telemedicine platforms, analyze user behavior to understand the proportion of users who are substituting existing in-person visits versus those seeking new care. Use this data to inform marketing, pricing, and operational strategies.

Project actions

  • 01When researching a new technology or service, consider how it might replace existing solutions rather than just add to them.
  • 02Look for data that shows actual behavior changes, not just potential use.
03

Method & Evidence

AimTo causally assess the degree to which direct-to-consumer telemedicine consultations substitute for in-person primary care consultations among young adults.
MethodFuzzy difference-in-discontinuities analysis
ProcedureThe study analyzed exogenous changes in patient fees for telemedicine services in Sweden to determine the causal impact of these changes on the substitution between online and in-person doctor consultations for young adults.
ContextHealthcare sector, specifically primary care and direct-to-consumer telemedicine services.

Variables

IVExogenous changes in patient fees for telemedicine services.
DVProportion of DCT consultations substituting for in-person consultations.
CVYoung adults in Sweden, primary care consultations.
04

Strengths & Limitations

Strengths

  • +Utilizes a robust quasi-experimental design (fuzzy difference-in-discontinuities) to establish causality.
  • +Provides quantitative evidence on the substitution effect of telemedicine.

Limitations

The study's focus on a specific demographic and region might limit its universal applicability. The definition and measurement of 'new utilization' could be further explored.

Reliability & validity

The use of a difference-in-discontinuities design strengthens internal validity by exploiting a natural experiment. External validity may be limited by the specific context of the study.

Think critically

If 55% of DCT consultations represent new utilization, what are the implications for healthcare systems and the potential for increased overall demand and costs, despite the substitution effect?

05

Design Principles

"Digital health solutions should be designed to complement and substitute for traditional care pathways, optimizing resource utilization and patient access."

Understanding the substitution effect of new service delivery models like DCT is crucial for businesses in the healthcare sector. It informs strategic decisions regarding resource allocation, pricing, and the potential impact on market dynamics and overall healthcare costs.

06

What This Means for Your Design

Online doctor appointments are replacing nearly half of in-person doctor visits for young adults, meaning people aren't just going to the doctor more often, they're switching how they get care.

How to use in your project

  • 1.This research can be used to justify the design of a hybrid service model, arguing that digital components can efficiently substitute for some in-person interactions.
07

Add to My Project

08

Quick Cite

Paragraph starter

Research indicates that direct-to-consumer telemedicine services can significantly substitute for traditional in-person consultations, with approximately 45% of online visits replacing prior in-person appointments. This suggests that innovative digital health solutions can be designed to optimize resource allocation and patient access by offering efficient alternatives to established care pathways.

09

Source

The Economic Journal

An App Call a Day Keeps the Patient Away? Substitution of Online and In-Person Doctor Consultations Among Young Adults

journal · 2026

View source

Questions About This Research

What does the research say about direct-to-consumer telemedicine substitutes for 45% of in-person doctor visits?
When designing healthcare services, consider the potential for new digital offerings to substitute for existing in-person services, rather than solely adding to demand, and focus on seamless integration. Evidence: The Economic Journal (2026).
Why does "Direct-to-Consumer Telemedicine Substitutes for 45% of In-Person Doctor Visits" matter for design?
Understanding the substitution effect of new service delivery models like DCT is crucial for businesses in the healthcare sector. It informs strategic decisions regarding resource allocation, pricing, and the potential impact on market dynamics and overall healthcare costs.
How can designers apply this research?
When designing healthcare services, consider the potential for new digital offerings to substitute for existing in-person services, rather than solely adding to demand, and focus on seamless integration.
What were the main findings?
45% of direct-to-consumer telemedicine consultations replace in-person visits.. The remaining 55% of DCT consultations represent new utilization, not replacements.. The increase in volume due to DCT may be close to cost-neutral.. There is no evidence that the quality of care deteriorates with increased use of online consultations.
What research method was used?
Fuzzy difference-in-discontinuities analysis.
How strong is the evidence?
Evidence strength is rated Strong effect, based on a 2026 journal from The Economic Journal.
What should I do differently in my next project?
When developing or refining telemedicine platforms, analyze user behavior to understand the proportion of users who are substituting existing in-person visits versus those seeking new care. Use this data to inform marketing, pricing, and operational strategies.
What are the limitations?
The study focused on young adults in Sweden, and findings may not be generalizable to other age groups or geographical regions. The 'new utilization' aspect warrants further investigation into its drivers and implications.