But concerns about consistency, followup care, equity issues raised by experts
Virtual health care is not exactly a new idea in Canada, but it is becoming another way for companies to offer digital benefits that appeal to time-challenged workers.
And there is a great appetite for more virtual health care, according to a survey done by Hill + Knowlton for Wello, a virtual health-care service provider.
“Nearly nine out of 10 (people) said they would use virtual care, but when you look at the rates of people using it in Canada, we’ve only got 15 per cent using web chat, 11 per cent using video calls for medical appointments,” said Vince Danielsen, president and CEO of Wello in Calgary.
“That’s well behind other countries, and what it shows is that there’s a really large void to fill.”
But virtual health is being noticed by the federal government and Health Canada, with recognition that digital health technologies — such as standalone software applications or integrated hardware and software systems on computers, smartphones and wearables — can improve access to health-care information, facilitate more timely diagnoses and treatments and improve access to care for patients at home, health-care facilities, as well as in rural and remote communities.
Health Canada announced in April it is creating a new division to “allow for a more targeted pre-market review of digital health technologies, to adapt to rapidly changing technologies in digital health, and to respond to fast innovation cycles.”
People are not only receptive to using virtual care, they place great value on it, said Danielsen.
“Seventy-four per cent of Canadian employees believe better health benefits are as (important) — or more important than — higher wages,” he said.
“When you look at digital benefits and you start to look at the trends in the marketplace (people are saying), ‘Do I want to get paid a few more dollars and would I like to get help for these large burgeoning concerns in my life?’ And I think you’re getting people to shift over and say, ‘Please provide me with some more support.’”
“There’s quite a large mind shift going on in the benefits world,” said Danielsen.
The survey of 1,500 Canadians also found 73 per cent of respondents took time off from work to physically attend a doctor’s office.
“Thirty-nine per cent of employees took between two to six days annually away from work to go to doctor visits,” said Danielsen. “And when you look at families, it’s even a larger amount.”
By integrating virtual-care services into benefits packages, employers can reduce absenteeism and the associated costs, he said.
“(It’s about) this ability to keep people at work and not having to leave work for using sick days.”
And it’s not just for initial care, said Danielsen. Through online health portals, employees can also undergo virtual visits (phone and video) with a team of nurse practitioners for followup care regarding issues such as chronic disease management and mental-health counseling.
Followup care is crucial to good health outcomes, and that means visiting with the same doctor, said Sohail Gandhi president-elect of the Ontario Medical Association in Stayner, Ont.
“We know that having consistency of approach, seeing the same physician on a regular basis, makes a big difference in terms of reducing hospitalizations, improving health-care metrics — however you choose to measure them.”
Without ongoing care from the same doctor, virtual providers run the risk of harming patients, he said.
“My concern is that it takes a doctor who knows you well to properly use the virtual health-care services, and there’s this service that’s being offered by a private company, and if you go there with an illness, you’ll see one person and if the illness doesn’t get better and you come back, you’ll see another person,” said Gandhi.
“And if it’s still not better, you’ll come back a week or two later, and you see a third — there’s no consistency there.”
Anything that has a positive health outcome that can be developed within the public health-care system should be investigated, according to Monika Dutt, board member of Canadian Doctors for Medicare from New Liskeard, Ont.
“I do a lot of work in rural and remote communities; there’s a lot of virtual health-care use there,” she said. “The types of setups probably have some positive aspects that we should be putting more into our public health care.”
However, the fact that these providers charge a monthly free for services is troublesome, said Dutt.
“I do have some concerns when a parallel process gets put in place, particularly when there’s a cost to it because already there’s a barrier for people who may not be able to access that, as well as other concerns around a continuity of care. People often end up going back to their primary-care providers after being seen in a different, separate setting from their own primary health care.”
In Canada, there is an equity principle to make sure everybody has access to the same type of services — no matter their status or insurer, said Aude Motulsky, research scientist at the University of Montreal Hospital Research Centre.
“And, for now, because the public health-care system is struggling with integrating these type of technologies, we’re seeing this happening only in certain types of settings, like certain private insurance — but this is not how the health-care system in Canada is built and the Canadian laws written,” she said.
“Why only some people would have access to a service that is preventing them to miss one day at work because they can’t afford it — this is where it starts to create inequity.”
“We have a big challenge in terms of how are we going to reconcile the need, the way the technology is evolving, and the way the public health-care system is able to integrate innovation,” said Motulsky.
But if virtual care is properly integrated into the public system, it could relieve some of the burdens facing health care, said Dutt.
“People are not going to their doctors’ offices so much now (even though) employers tend to require employees to get a note from their doctor, which many medical organizations have said is an unnecessary use of care.”
“If we eliminated that, that would also decrease your need to go to see your health-care provider,” she said.