A DECISION MODEL FOR CONTROLLING OUT-OF-POCKET EXPENSES THROUGH TELEMEDICINE ENGAGEMENT IN PRIMARY CARE

ABSTRACT In resource-constrained developing countries like India, delivering low cost primary care services is a challenge. Patients requiring primary healthcare spend a sizeable amount on travel, medicines, diagnostic services etc. that leads to a rise in out-of-pocket (OOP) expenses. Encouraging telemedicine practices for primary healthcare can be helpful in reducing OOP payments by patients. Additionally, telemedicine also holds the potential to handle sudden healthcare demand in pandemics like COVID-19. This article presents an optimization model for regulating OOP payments by integrating telemedicine services in existing primary healthcare network. The objective is to maximize patient coverage by regulating OOP expenses simultaneously. A trade-off between new facilities and telemedicine services is to be obtained for this purpose. Solution methods based on greedy search and genetic algorithm have also been provided. The algorithms are novel as they are based on cost-effectivenss of the facility/telemedicine center that is driven by OOP expenses and establishment cost. Numerical experiments have been conducted for validating the proposed model and to derive useful insights for policy making.