TY  - JOUR
AU  - Mainer-Pearson, Graham
AU  - Stewart, Kurtis
AU  - Williams, Kim
AU  - Pawlovich, John
AU  - Graham, Scott
AU  - Riches, Linda
AU  - Cressman, Sonya
AU  - Ho, Kendall
PY  - 2025
DA  - 2025/2/19
TI  - Estimating Patient and Family Costs and CO2 Emissions for Telehealth and In-Person Health Care Appointments in British Columbia, Canada: Geospatial Mixed Methods Study
JO  - J Med Internet Res
SP  - e56766
VL  - 27
KW  - virtual care
KW  - economic evaluation
KW  - patient costs
KW  - lost productivity
KW  - informal caregiving
KW  - out-of-pocket costs
KW  - environmental costs
KW  - geospatial
KW  - patient
KW  - family
KW  - CO2
KW  - emission costs
KW  - health care
KW  - Canada
KW  - virtual service
KW  - emergency department
KW  - hospitalization
KW  - physician visit
KW  - consultation
KW  - sensitivity analysis
KW  - patient-paid
KW  - telehealth
AB  - Background: Patients inevitably incur some cost for accessing health care, even in universal systems such as Canada. The COVID-19 pandemic dramatically shifted health care delivery from in-person to telehealth services, also shifting the proportion of costs offset by patients and their families by reducing the need to travel to in-person appointments. Objective: This study aimed to develop a method for estimating the costs patients and their families incur and CO2 emissions attributed to travel needed for emergency department (ED) visits, hospitalizations, and physician appointments. Methods: We present a method to evaluate the costs associated with in-person and telehealth care appointments from the perspective of patients, their families, and the environment. We used ED locations, road distances, and duration of appointment to account for costs paid by patients (ie, lost productivity, informal caregiving, and out-of-pocket expenses) attributed to travel to receive medical care. Costs to the environment were evaluated by calculating the amount of CO2 emitted per medical visit. Using our costs calculated per visit, we apply our method to calculate total patient costs for a simulated population over 1 year. Results: Our method estimates that patients in British Columbia pay up to $300 (2023 CAD, CAD $1=US $0.86) on average to attend an in-person ED visit, depending on where they live; $166 may be attributed to lost productivity, $83 to informal caregiving, and $50 to out-of-pocket expenses. These estimates are higher than most observed cost estimates. In addition, avoiding in-person care diverts up to 13 kg of CO2 per medical visit, depending on the distance and frequency of travel to appointments. This translates to up to $0.70 in carbon costs per visit, or cumulatively $44,120 per year in British Columbia, conventionally not included in patient cost estimates. Conclusions: We present a novel method for estimating patient-incurred costs and CO2 emissions from accessing health care and apply it to estimate that every year, patients in British Columbia pay upwards of 30 million dollars to access health care services, primarily for medical travel. Our method adds to the economic evaluation literature by providing a more comprehensive and context-modifiable calculation of patient costs that will allow for more informed decision-making regarding health care services. 
SN  - 1438-8871
UR  - https://www.jmir.org/2025/1/e56766
UR  - https://doi.org/10.2196/56766
UR  - http://www.ncbi.nlm.nih.gov/pubmed/39969971
DO  - 10.2196/56766
ID  - info:doi/10.2196/56766
ER  -