Financial Simulation of Remote Healthcare Implementation Strategies in Türkiye: A Monte Carlo Analysis Based on...

The expansion of universal health coverage in Türkiye has intensified pressure on public healthcare providers through high outpatient volumes that strain capacity and financial sustainability. Remote healthcare delivery has emerged as a potential strategy to improve efficiency and access. However, limited evidence exists on how remote outpatient care should be implemented across medical specialties within a universal payer system, or how alternative implementation strategies perform financially. This study evaluates the specialty-specific feasibility and financial impact of remote outpatient care using comprehensive administrative data from a large public training and research hospital in Izmir, supplemented by qualitative input from clinical specialists. The analysis includes 577,984 outpatient visits recorded in 2022 across major medical specialties. Eligibility for remote delivery is identified using observable clinical proxies-imaging requests, laboratory tests, and prescription issuance-to capture visits not requiring physical examination or procedural intervention. Results show that 121,248 visits (21.0%) are suitable for remote delivery, accounting for 16.2% of expenditures ($0.68 million out of $4.20 million). Remote eligibility varies substantially across specialties, with high suitability in dermatology and infectious diseases but limited applicability in device-dependent fields such as pulmonology. Four implementation scenarios are simulated over a 10-year horizon: Regulatory Compliance, Evidence-Based Specialty-Specific, Follow-Up Only, and Hybrid Progressive. The Regulatory Compliance scenario yields the shortest break-even period (3 years) and highest ROI (1185%). The Hybrid Progressive scenario, incorporating phased specialty expansion and AI-supported triage, requires higher upfront costs but generates the largest cumulative net savings ($1.39 million). The findings demonstrate that financially sustainable remote outpatient care can be achieved through carefully designed, specialty-specific implementation strategies.