{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T09:08:16Z","timestamp":1787908096579,"version":"build-2784847793"},"reference-count":44,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n The effects of telemedicine on health expenditures and health outcomes are an important policy question. Many countries loosened regulations on the use of telemedicine during the COVID-19 pandemic, thereby offering an opportunity to evaluate these effects via a natural experiment.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to assess the effect of greater telemedicine use on area-level health expenditures and health outcomes related to common chronic conditions in Japan during the COVID-19 pandemic.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We compared prefectures (area levels of government) with higher prepandemic telemedicine rates (fiscal year [FY] 2019) versus those with lower rates and conducted a difference-in-differences analysis of the change in prefecture-level health expenditures from FY2017 to FY2022 and health outcomes from FY2017 to FY2021. The participants were the total population in Japan from FY2017 to FY2022 (n=126 million), and the exposure was the increase in telemedicine use following the government\u2019s relaxation of restrictions on telemedicine use as an exceptional measure during the COVID-19 pandemic. Our main outcomes were the share of outpatient claims that were for telehealth services; total, inpatient, and outpatient annual prefecture-level health expenditures; all-cause mortality,\n \n glycated hemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Treatment prefectures (n=15, population of 62 million) were defined as those with greater-than-median telemedicine use before the pandemic, while control prefectures (n=32, population of 64 million) were defined as those with less-than-median telemedicine use. Treatment and control prefectures shared similar demographic characteristics before the pandemic. The growth in telemedicine after 2020 as a share of outpatient claims increased among the treatment prefectures by 0.35 percentage points more than among control prefectures, which represented more than a threefold increase in telemedicine use compared to the prepandemic median. In difference-in-differences analyses, this difference was associated with a 1.0% relative decrease (95% CI 0.3%-1.8%) in total health expenditure (\n P<\/jats:italic>\n =.006) and a 1.1% relative decrease (95% CI 0.2%-2.0%) in inpatient expenditure (\n P<\/jats:italic>\n =.02). Outpatient expenditures showed no significant difference as a result of increased telemedicine adoption. Most health outcomes\u2014all-cause mortality,\n \n glycated hemoglobin, systolic blood pressure, diastolic blood pressure, and low-density lipoprotein cholesterol\u2014did not show any significant changes.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Areas in Japan with greater expansion of telemedicine use during the pandemic experienced a significant decrease in both inpatient and total health care spending compared with areas with less telemedicine use, without harming health outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/72051","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T20:45:13Z","timestamp":1758660313000},"page":"e72051-e72051","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Telemedicine on Health Expenditures During the COVID-19 Pandemic in Japan: Quasi-Experimental Study"],"prefix":"10.2196","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1628-4142","authenticated-orcid":false,"given":"Hikaru","family":"Aihara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9339-2821","authenticated-orcid":false,"given":"Ichiro","family":"Kawachi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6507-6047","authenticated-orcid":false,"given":"Benjamin D","family":"Sommers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"R1","doi-asserted-by":"crossref","unstructured":"The COVID-19 pandemic and the future of telemedicine. 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