Inhibiting and Promoting Factors for the Use of Video Consultations Among Individuals Covered by Statutory Health Insurance in German Outpatient Care: Cross-Sectional Study

TL;DR

This study explores why video consultations are rarely used by German health insurance patients, finding that lack of availability and concerns about care quality and data protection are major barriers.

Contribution

The study identifies subgroup-specific inhibiting and promoting factors for video consultation use among German statutory health insurance patients.

Findings

Only 6.7% of respondents had used video consultations, despite 75.3% expressing interest.

Lack of VC availability by physicians was the biggest obstacle for those with little or no experience.

Older individuals and those with chronic conditions reported higher concerns about data protection and stress.

Abstract

Video consultations (VC) have proven to be a useful tool to enhance access to medical care for patients. During the COVID-19 pandemic, the use of VC has risen sharply. However, since (the end of) the pandemic, they have only been used to a limited extent by insured individuals in the German statutory health insurance (SHI).

The aim of this survey is to identify inhibiting and promoting factors for the use of VC in the SHI-insured population.

Survey documents were distributed by 3 participating SHI funds to 33,816 insured individuals in 4 selected German federal states. Participation was anonymous and available in paper format or online via a QR code. Both descriptive methods as well as inferential statistics were performed for analysis. Subgroup analysis included evaluations based on gender, age groups, community size, chronic disease, and previous VC experience.

The response rate was 13.9%, resulting in 4600 included questionnaires from the 33,816 individuals approached. Although 75.3% (3132/4162) of the insured were interested in using VC in general, only 6.7% (302/4511) of them had used it at the time of the survey. Among respondents with little or no VC experience, 88.3% (2763/3129) stated that the lack of VC offered by physicians was the biggest obstacle to VC use. Other relevant inhibiting factors were concerns about the quality of medical care (1573/3589, 43.8%) and data protection (948/3861, 24.6%). A lack of technical equipment and a stable internet connection tended not to be an obstacle in the survey. Comparing subgroups, associations were identified in particular between the inhibiting factors and age groups as well as between the inhibiting factors and the presence of a chronic illness. With increasing age, participants were more likely to have data protection concerns (P<.001, Kendall Tau-c=0.128) or perceive VC as exhausting (P<.001, Kendall Tau-c=0.136). Similarly, participants with a chronic condition were more likely to perceive VC as stressful (chronic condition: 247/1177, 21% vs no chronic condition: 257/1847, 13.9%; χ²2=30.209, P<.001; Cramer V=0.1). The most relevant promoting factors were that a video application works without interruption (3624/3911, 92.7%) and that it is easy and intuitive to use (3674/3978, 92.4%).

The results suggest that insured individuals are interested in using VC but were rarely offered VC appointments. Therefore, it is important to reduce potential obstacles on the part of the service providers, who are currently limiting the availability of VC. Existing hurdles can best be addressed by targeting subgroup-specific hurdles as they tend to vary between subgroups.