The consolidation of virtual consultation in the Primary Care Centers of rural areas could save up to €117 M per year

The virtual consultation and the technological tools of remote medicine can play an important role in improving the efficiency of the health system of rural municipalities in Catalonia and, at the same time, avoid various costs for society (travel, opportunity costs, polluting emissions...). The study Digital Health Ecosystem Report prepared by the Cambra de Barcelona and Barcelona Health Hub estimated that the implementation of virtual consultation in primary care in rural areas would save society up to €117 M per year (the total for Catalonia as a whole would be up to €342 M). Thus, the savings for the rural population -those living in municipalities with less than 5,000 inhabitants and/or a population density of less than 300 inhabitants per km²- would represent 34% of the total of these 342 M€, a figure much higher than its weight in the population, 17%. It should be noted that Catalonia has 949 municipalities, of which 790 (83%) are considered rural. By items, if virtual consultation in these rural areas had been consolidated (60% of the total number of visits), the savings in medical visits would be €72 M per year, while in nursing care it would be €45 M per year. Taking these figures into account, virtual medical care could contribute to reducing territorial inequalities in healthcare and other public services between rural and urban populations. In this sense, the implementation of virtual consultation would not only be relevant for reasons of territorial equity, but also for cost reasons. For this cause, the study has calculated the savings by differentiating between urban and rural populations, with the aim, especially, of estimating the potential benefits for the population living in rural areas where costs and travel time are higher:

• Savings in transportation costs. Virtual consultation avoids the patient having to travel to the health center and, therefore, reduces the expenses associated with the cost of transport. According to a study by the Bank of Spain, the average distance from a rural municipality to a local service is 12.85 km, while in the case of an urban center, this distance is reduced to 2.12 km.
• Savings in polluting emissions. In addition to the reduction in transportation costs for patients' pockets, there is also a saving for society in terms of reduced emissions of polluting gases when traveling to the care center.
• Savings in opportunity costs. When we talk about opportunity cost, it is referring to the time that the patient spends on the consultation and that, for example, is not dedicated to carrying out an economic activity.

It is important to point out that the savings generated by the public healthcare system as a result of virtual consultation or other solutions related to digital health can be used to cover a new demand for healthcare services, without the need to increase the budget. It is fair to say that digital health has to seek a balance between the digitalization of patient care and face-to-face. The technology must allow access to face-to-face care to be of high quality and when conditions require it. As the WHO explains, telemedicine is a useful complement to face-to-face interaction, but does not replace it completely.