Scaling Up Telemedicine Services in Ukraine: A Scenario-Based Assessment of Economic Effects and Break-Even Thresholds

Abstract

The economic effects of scaling up telemedicine services depend on infrastructure utilisation, the cost structure, and the proportion of remote interactions that effectively replace in-person visits. In Ukraine, assessment of these conditions is constrained by the absence of standardised cost accounting and data on the actual substitution of in-person care.To assess changes in the fixed-cost component per service as the volume of telemedicine services increases in Ukraine, determine the break-even conditions for healthcare providers and the healthcare system, and estimate the opportunity cost of paid working time saved by patients and accompanying persons.A secondary analysis of publicly available data for 2021–2023 was conducted. The methods included the classification of fixed, variable, and step-fixed costs; cost–volume–profit analysis; break-even analysis; and scenario analysis. The study considered the healthcare provider, healthcare system, and societal perspectives. Cost estimates from other countries were used solely as relative scenario parameters.The number of registered remote interactions in Ukraine increased from 5.7 million in 2021 to 9.8 million in 2023. Assuming constant total fixed costs, the fixed-cost component per interaction decreased by 41.8%. The overall change in average cost cannot be determined without data on fixed and variable costs. In the normalised scenario that included only direct medical costs, system-level break-even was not achieved even when remote consultations fully replaced in-person consultations. When patients’ travel costs were included, the break-even substitution rate was approximately 92.8%; when intermunicipal travel was considered, it decreased to 86.9%. At a volume of 9.8 million remote interactions and a 50% substitution rate, the estimated annual time saved ranged from 4.9 million to 14.7 million person-hours. Across the scenarios examined, its monetary value ranged from UAH 219.1 million to UAH 1,314.6 million.Increasing the volume of telemedicine services reduces the fixed-cost component per service only within existing capacity. Break-even depends on the cost structure, revenue per interaction, the actual substitution rate, and the amount of avoidable costs. Estimating break-even thresholds for Ukrainian healthcare institutions requires separate accounting of costs, subsequent in-person visits, travel expenses, and the time spent by patients and accompanying persons.