Video visits go viral: COVID-19 sparks growth in video doctor’s visits

Of all the activities that COVID-19 brought online, video doctor’s visits may be the one that caused the most personal trepidation. After all, how can a doctor take your blood pressure, examine your throat, or evaluate a skin tumor over Zoom or Skype? But as it turns out, many consumers (and doctors) have been quick to change their minds about video visits’ efficacy and appeal, and they are now prepared to do it that way for the long term.

We predict that the percentage of virtual video visits to doctors will rise to 5% globally in 2021, up from an estimated 1% in 2019.¹ While 5% may not sound like much, consider that 8.5 billion doctor’s visits, worth a total of approximately US$500 billion, took place in the Organisation for Economic Co-operation and Development (OECD) 36 countries in 2019 alone. Five percent of that would translate into more than 400 million video visits and about US$25 billion in value, depending on how much doctors are paid (either directly by a patient, by insurance, or by national health insurance) for video visits compared to in-person ones.

The relationship of this growth to COVID-19 is clear. In April 2020, 43.5% of all US Medicare primary care visits were via telehealth; prepandemic, this figure stood at just 0.1%.² While telehealth also includes phone calls, emails, and nonvideo software solutions, the number of visits by video rose greatly. The number of people using the Department of Veteran’s Affairs Video Connect system rose to 120,000 per week, compared to 10,000 per week in the same period in 2019.³ Meanwhile, in the spring of 2020, video consultation services in France rose by 40%–100%.⁴ And in a May 2020 survey, 14% of Canadians said they would choose a video doctor’s visit where possible going forward.⁵

More video and other types of virtual visits mean more business for the companies providing the technologies to support them. We predict that the market for pure-play telehealth virtual visit solutions will reach US$8 billion in 2021.⁶ Partially driven by the growth in virtual visits, we also expect that more than US$33 billion of medical-grade home health care technology (mainly therapeutic and monitoring solutions, which can include medically approved consumer products such as smart watches) will be sold in 2021, up almost 20% over 2019.⁷

What happened?

The technology for video visits has been around for years. However, several factors—COVID-19 foremost among them—are converging today to drive higher usage.

COVID-19 left people no choice, and regulatory barriers were lowered

In March 2020 alone, authorities in the United Kingdom, United States, and Germany loosened regulatory barriers, modified rules around privacy, and endorsed telemedicine, including video visits.⁸ To quote one UK doctor: “We’re basically witnessing 10 years of change in one week.”⁹

COVID-19 also forced people to learn how to use the software. During the pandemic, literally hundreds of millions of people who had never used videocalling software and hardware before used it for the first time as they worked from home during lockdowns. Even before the pandemic, videocalling was relatively easy to use … but many people hadn’t. Postpandemic, almost everyone is now a veteran at setting it up, getting lighting levels right, muting and unmuting themselves, and so on.

Importantly, the newly skilled at videocalling includes tens of millions of people over age 65, who visit doctors more frequently than younger individuals. Although only 17% of the population, the 65-plus demographic accounts for more than 30% of all doctor’s visits in the United States;¹⁰ in 2016, people age 65 and up made 80% more office visits than the average number of visits among the general US population. Historically, research has shown that elderly users, even when they have the right tools and connections, are still less likely to use digital applications, in part due to unfamiliarity.¹¹ COVID-19 provided the impetus for them to change that. To stay in touch with children, grandchildren, and friends, the 65+ population underwent a rapid and forced training on video hardware and software. For them to be able to use it for virtual video visits with physicians is a fringe benefit that can drive substantial growth in the video visit market.

Devices and connections are reaching critical mass, especially among the elderly

The generational divide in digital device ownership has been rapidly narrowing in the last five years. As more older people become equipped to come online, their ability to engage in virtual visits will increase—an important consideration for those with limited mobility or other constraints that make it difficult to go to the doctor in person.

Historically, although the devices needed for video calls (laptops, smartphones, and tablets) have been broadly ubiquitous, their ownership has been much less widespread among those over 65. However, as figure 1 illustrates, this has begun to change. In 2015, one in three Britons age 65 to 75 did not own a device capable of supporting a medical video call. By 2020 that figure had fallen to 1 in 25 as more older adults bought tablets and especially smartphones.

Connectivity’s reach and speed are improving

Virtual visits’ growth will depend partly on the extent to which more of the world’s population becomes connected. As of 2017, about 12% of rural residents in the United States lacked access to fixed internet service of up to 10 megabits per second (Mbps) download and 1 Mbps upload.¹³ Furthermore, these speeds are maximum speeds: During periods of heavy use, when they are shared by multiple users in a home, speeds can be much slower. Most virtual video visit applications require at least 0.5 Mbps upload speeds, meaning that at times when connectivity is slower than the maximum for these users, their connections would not be able to support a video doctor’s visit.

It is also worth noting that access to connectivity is lower among certain populations besides those in rural areas. “Digital exclusion” is higher for those living in social housing, from lower-income groups, with visual and other disabilities, who are homeless or unemployed, who have lower levels of education, and whose first language is not the country’s native language(s).¹⁴ Because of this, these populations will likely be slower to adopt telemedicine in general and video visits specifically.

The connectivity situation, however, is slowly improving. Governments around the world, working with network operators, are trying to get more citizens connected to the internet, and at higher speeds, especially in rural areas. As telemedicine becomes increasingly important in delivering health care (once again, especially in rural areas), we can expect those initiatives to accelerate.¹⁵ It is also possible that llow Earth orbit satellite constellations may be able to provide high enough speeds for ubiquitous global coverage, though these networks are not yet in full service, and many questions about them remain, especially around affordability.¹⁶

5G will further accelerate telemedicine, as it allows for faster transmission of large image and high-quality video files, better augmented reality/virtual reality and spatial computing, and more reliable connections with guaranteed quality of service. In some cases, 5G could even allow telemedicine to move beyond diagnosis and monitoring, enabling doctors to perform actual procedures and surgeries using ultra-low latency (under 10 millisecond) virtual technology.¹⁷

COVID-19 may make video calling the default

Historically, most electronic communications for consumers and businesses have been email/messaging or voice-only calls, with video only used when absolutely required. Although we don’t have hard data for how that may be changing now, we see signs that, as one commentator has observed, “Video calling is the new normal, and it’s all because of coronavirus.”¹⁸ Some of video calling’s appeal may be due to the medium’s novelty, but if a preference for video over nonvideo methods is indeed rising, it has two critical implications for medical video visits. First, if we see a permanent shift to video over email and voice calls, then our prediction of 5% of all visits being video will likely be much too low. Second, video may make virtual visits much more medically effective. Obviously, a video call helps a health professional assess a laceration or rash, but it also has the benefit of showing the patient’s and health professional’s faces. A seminal 1979 study, long before video calling was widespread, concluded that “Effective nonverbal communication—facial expression, voice tone, etc.—is essential for successful patient‐practitioner interaction.”¹⁹

Sizing the global doctor visit market

Let’s return to our prediction for the revenue generated by video doctor’s visits. Why do we believe that video visits will be worth about US$25 billion in 2021?

The market for physical visits with doctors is very large, but although there are some sources that give the number of annual visits for a given country, no single source tallying global visits exists. Using two different approaches to size the market, we believe that patient visits to doctors (both physical and virtual) are likely to generate more than US$700 billion globally in 2021. OECD member states will account for more than half a trillion dollars of this figure in 2021; if 5% of these are virtual, that works out to about US$25 billion for video visits.

Methodology 1: Adding up per-country cost per visit

The OECD publishes data on annual per capita doctor consultations by country.²⁰ We multiplied the latest available data by each country’s estimated 2020 population to determine the number of annual doctor visits per country (figure 3). This analysis suggests that across the 36 OECD countries, with a total population of 1.31 billion people, more than 8.7 billion visits take place every year.