Impact of billing policy changes on telehealth use in Ontario: a population-based repeated cross-sectional study

As telehealth is being integrated into a regularly functioning system, policy makers have been adding some restrictions related to its use (e.g., modalities and pre-existing in-person relationship rules). We explored how the new policies impacted the levels of use across telehealth modalities and if the impact varied across sociodemographic and chronic condition groups of patients.

This is a population-based repeated cross-sectional study examining all outpatient visits in Ontario, Canada on a weekly basis from the week of January 1st, 2018 until the week of December 25th, 2023. We used linked health administrative databases of health services provided to all Ontario residents who are insured through the Ontario Health Insurance Plan (OHIP). We examined the total number of visits and the rates of in-person and telehealth visits per 1000 persons per week.

Across Ontario, there were 115,046,536 telehealth visits during the study time period (26.4% of all ambulatory care). There was a 6.7% reduction in telehealth and a 10% reduction in the number of physicians using telehealth at the beginning of December 2022 when the new policies were introduced. This was in the absence of a reduction of total ambulatory visits. The impact varied across medical specialties, patient age groups, rurality and chronic conditions, but seemingly not across sex or income quintiles. The use of video increased slightly over the study period with 1 in 4 telehealth visits occurring over video.

While the policy changes led to an overall reduction in telehealth use, the total ambulatory visits did not change, suggesting a shift of care from virtual to in-person. The adoption of video increased, but future studies should focus on exploring whether there are clear benefits of using video over telephone, as certain groups of patients may be impacted more than others.