Digital Health Services to Improve Financial Protection and Equitable Access to Care
Details
Background:
Financial protection is a core goal of health systems that aim to provide universal coverage. Digital health services that offer culturally safe, longitudinally integrated care may improve financial protection while reducing environmental impacts of medical travel, particularly in rural, remote, and Indigenous (RRI) communities where colonial-designed service delivery systems and travel routes impede access to care.
Approach:
An RRI advisory committee was convened to co-develop a patient-level geospatial model to estimate patient travel burden, out-of-pocket expenditure (OOP), productivity losses, and informal caregiving. Financial protection was assessed through reductions in catastrophic health expenditure (CHE), defined as OOP exceeding 40% of non-subsistence income on a bi-weekly basis. The GEOFFE model integrates administrative data, patient and clinic locations, and transportation statistics to estimate travel routes, modes, and time. It was internally validated using the Real-Time Virtual Support (RTVS) program and externally compared with existing travel cost calculators and patient surveys from RRI communities.
Outcomes:
Since implemented in 2020, the RTVS was estimated to have offset over $46 million in OOP, informal caregiving, and productivity losses in British Columbia. Among 286,000 patients who used the program, CHE was averted for 16,612 individuals with high travel burden and limited income, and 1.6 million kg of CO₂ emissions were avoided.
Results/Impact:
Intentionally designed digital services can reduce OOP costs, CHE incidences, and productivity losses, with the greatest benefits for rural patients requiring specialized care. Pediatric patients in IRR communities experienced the largest benefits, with an average of $388 in avoided OOP costs per patient. The model better identified rural inequities than existing approaches; a finding supported by survey responses. Among the 24 respondents, 36% cited travel costs as a major a barrier to accessing care, with individual responses highlighting gaps in reimbursement programs and insecurity in their need for food and safe overnight accommodations while travelling to receive medical care. These findings suggest that intentionally designed digital health services can improve financial protection, reduce environmental impacts, and enable more equitable access to care for RRI populations.
Learning objectives:
- Understand how intentionally designed digital health services can improve financial protection and equitable access to care.
- Apply financial protection concepts to evaluate the impacts of digital health programs in Indigenous, rural, and remote communities.
Sonya Cressman, PhD MBA
Evaluation Lead, Digital Emergency Medicine
Department of Emergency Medicine, Faculty of Medicine, UBC
Adjunct Professor, Simon Fraser University
Dr. Cressman is an established health economist advancing transformation and resilience. Her work has improved how equitable access to health services and financial protection are measured. As Evaluation Lead at UBC Digital Emergency Medicine (DigEM), and Adjunct Professor at SFU, she leads applied evaluations of digital health services that are designed to reduce inequities—particularly for patients in Indigenous, rural, and remote communities. Her research has informed multi-million-dollar healthcare decisions with national and international impact.