Telemedicine Gatekeeping Over 15,000 Patients from Specialist Consultation Waiting Lists: A Cost-Minimization Study

This study assesses the cost-minimization of the RegulaSUS telemedicine program, reducing the necessity for face-to-face specialist consultations.

A cost analysis study, utilizing a retrospective cohort design, was conducted from January 2017 to December 2019. The gatekeeping process for waiting lists for specialized consultations was performed by two groups: the RegulaSUS program through telemedicine intervention and those regulated by the usual procedures of the Ambulatory Regulation Center of the State of Rio Grande do Sul (the contemporaneous controls group). The primary outcome was to evaluate the financial impact of the RegulaSUS program on the health system costs using the Time-Driven Activity-Based Costing (TDABC) method.

The RegulaSUS program substantially reduced health care and societal expenditures, with gatekeeping by telemedicine costing $85.02 versus $214.45 for usual procedures-a 60% reduction. This intervention resulted in societal savings of R$7,833,882.56 over 36 months by successfully managing 15,064 patients within primary care settings, rather than referring them to specialists.

The RegulaSUS program demonstrates a remarkable economic impact by integrating evidence-based gatekeeping protocols with telemedicine infrastructure, effectively decreasing specialist demand. This intervention provides compelling evidence for the potential of telemedicine to optimize health care resource allocation, enhance care coordination, and improve system efficiency. The outcomes present a scalable, financially sustainable model for health system strengthening that merits consideration for broader implementation across Brazil's public health network and adaptation to comparable global health care contexts facing similar resource constraints.