JMIR Publications

ABSTRACT

Background:

Background:

As the internet-based healthcare services have demonstrated significant advantages in the providing of qualified and accessible care, health insurance payment for internet-based healthcare services have been issued by various countries. However, the optimization of health insurance payments for internet-based healthcare services remains uncertain.

Objective:

We conducted a systematic review of the current situation regarding health insurance payments for internet-based healthcare services, with the aim of providing evidence to enhance policies related to health insurance payments for such services.

Methods:

Methods:

This systematic review was conducted by comprehensively retrieving date from six electronic bibliographic databases from inception until October 2023. The databases included China National Knowledge Infrastructure (CNKI), Wan Fang, Weipu Database (VIP), Web of Science, PubMed, and Embase, following the PRISMA guidelines. Two authors independently assessed search results, extracted data, and evaluated the quality of the included studies. After the initial screening of titles and abstracts, full texts were obtained and examined. The following data were extracted and analyzed: first author, date of publication, country, type of internet-based healthcare services introduced in health insurance, health insurance reimbursement providers, reimbursement standards for internet-based healthcare (e.g., the condition for the reimbursement and reimbursement rate), and key findings of studies. Moreover, we also conducted a narrative synthesis to summarize and report the findings.

Results:

Results:

A total of 7232 articles were retrieved. Following quality assessment, 23 articles were finally included, with the covered countries including China, the United States, Australia, France, Japan, UK, and Germany. The forms of the services vary across different regions, mainly including online consultation services, online medical monitoring services, online mental health services, online health education services, online surgical guidance services and other services. Payment standards are generally categorized into fee-for-service and global budget payment, with clear health insurance payment quotas or proportions and certain restrictions (e.g., specifying the location of medical visits, setting the limitation on distance from home to hospitals or setting a prerequisite for reimbursement is the referral of primary doctors). The paying entities for health insurance payment include national health insurance and commercial health insurance. In addition, there are two kinds of reimbursement rates: a comparable rate for both internet-based and in-person healthcare services, and a lower rate for internet-based services compared to in-person healthcare services.

Conclusions:

Conclusions:

To enhance the accessibility of internet-based services through health insurance payment, it is crucial to further refine the design of health insurance payment for internet-based healthcare and strengthen the supervision of services quality, bridging the gap between internet-based and in-person healthcare services.