​Telehealth regulations: a turning point

Countries are facing a turning point in the expansion of telehealth, having been left with flexible and fragmented regulations following Covid-19. Regulations play a crucial role in either restricting or expanding access to telehealth services. Not only will this article deep dive into Germany, a pioneer in regulating telehealth, but it will also highlight the key opportunity that telehealth regulation poses for telcos.

What is telehealth?

Whilst the terms telehealth and telemedicine are often used interchangeably, STL Partners understands telehealth to be a form of digital healthcare transcending geographical boundaries by utilizing video and voice communication technology. Telehealth has the capacity to increase the accessibility and convenience of healthcare and thus it has the potential to improve health outcomes for many people.

How can telehealth be regulated?

Telehealth regulations, as well as recommendations and guidelines, vary greatly between countries and can often be unclear and complex. There are multiple strategies that are used at the national, or occasionally federal, level to regulate telehealth services.


Figure 1: Telehealth regulations encouraging or restricting adoption

Strategies to expand the use of telehealth can simply include legalising platforms, devices, or mobile applications to facilitate telehealth or going further to incorporate these telehealth enablers into public health frameworks. Financial incentives are also an effective way of advancing telehealth use, paying health specialists the same amount of money for virtual consultations as they would receive for their face-to-face appointments.

As well as refusing to legalise telehealth, other obstructive policies can include: necessitating initial or regular face to face consultations to access virtual services; limiting telehealth to certain services, blocking access to virtual specialist care; preventing access to electronic records or data transfer, inhibiting effective virtual consultations; and blocking prescriptions via digital services.

Unsurprisingly, the Covid-19 pandemic has accelerated the use of telehealth services to varying extents globally. In fact, McKinsey estimate that telehealth use has increased 38 times from pre-pandemic levels. This rapid expansion of telehealth has been facilitated by temporary regulations and the waiving of pre-existing legislation, resulting in a fragmented and diverse landscape of telehealth regulation.


Figure 2: Global examples of current telehealth regulations following COVID-19

Source: STL Partners with insights from DLA piper report

Thus, it is clear that Covid-19 has brought about regulatory changes to telehealth in varying forms across the world. Some countries, such as South Korea and Japan appear to remain hostile to permanently easing legislative barriers to accessing telehealth. In contrast, positive changes such as introducing seemingly permanent telehealth incentives, as done in France and the USA, indicate that some countries are looking to expand their use of telehealth.

Now is a crucial turning point for telehealth regulations in many countries, as flexible and temporary forms of legislation in place due to Covid-19 will need to be evaluated. Using Germany, a forerunner in telehealth regulations, as an example, it is helpful to envisage the future of telehealth regulations and legislative changes to ensure a positive, accessible, and secure expansion of telehealth.

Deep Dive: Germany

Unlike many countries which are looking to potentially alter their telehealth regulations due to the experience of Covid-19, Germany had an established regulatory framework for telehealth prior to the pandemic. The progressive German Digital Healthcare Act of 2019 unlocked widespread possibilities for telehealth use. The act made Germany the first country in the world to allow prescriptions, reimbursements, and medical advice through digital apps with eleven currently approved in the country, aiding various issues including depression, sleep disorders and headaches.

Covid-19 has further accelerated telehealth use in Germany: remote treatment has been legalised; it is now mandated that patient records must be available electronically; and, from 2022, e- prescriptions legally must be offered as an option to patients. Furthermore, since the pandemic, medical apps can be given a ‘fast track’ route into the market so that they are available for healthcare professionals to use within 3 months.

These regulations, which actively encourage the use of telehealth services, mean that the mobile medical app market in Germany will continue to grow, by an estimated 23.6% by 2026. The new legislation requires apps be approved by a regulatory body, also allowing telehealth to be effectively integrated into the public health system.

Whilst the German example isn’t the only pathway countries can choose to follow as they look to regulate telehealth services, it serves as a good example of how telehealth can become a trustworthy, convenient, and accessible part of a country’s health system.

What do changing telehealth regulations mean for telcos?

Covid-19 has accelerated the adoption of digital healthcare by at least four years (see this STL report for further details) and the rapid changes in telehealth regulations globally suggest that an exponential increase in telehealth use is imminent. This inflexion point, coupled with operators’ potential advantage to play in this space (trusted and heavily regulated brand, local player, skills in data management and security etc.) makes telehealth an exciting opportunity for telcos looking to go beyond connectivity and instead work across the value chain.

Thus, telcos, particularly those operating in countries looking to expand telehealth use through regulatory changes, should capitalise on this opportunity by building experience and credibility in the industry.

Many telcos have already recognised this potential opportunity in telehealth. Prior to Covid-19 we highlighted TELUS as an innovator in digital health as well as ten other telcos that were exploring the industry. Furthermore, undoubtedly sparked by the pandemic, increasing numbers of telcos are entering the telehealth industry such as HKT launching a new consultative app ‘Dr Go’ and Verizon acquiring BlueJeans to expand its telehealth services, both in 2020.

Author:Izzy Montgomery, Consultant at STL Partners, specialising in digital health.

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