“Stuck in the waiting room”

Highlights of this article recently published on the Economist:

The idea of telemedicine has a lengthy history. Radio News, an American magazine, devoted its cover to a patient at home consulting a doctor in his surgery via a television link as long ago as 1924. When NASA began monitoring astronauts in space in the 1960s, fantasy became reality. It has been touted as health care’s future ever since. But, still, most health care happens face to face.  Now, enthusiasts think the wait is almost over.  Governments have been too slow to embrace an approach that could improve coverage and outcomes and save money. But they are under big pressure for ageing populations and a surge in chronic diseases.

At an industry conference in Rome on October 7-9, it was discussed to redesign laws and payment systems and find ways to keep patient data secure and private. In America, each state license doctors and the jurisdiction depends on the patient’s location, not the doctor’s. The situation in the European Union is simpler: countries may not pass laws that would stop doctors practicing telemedicine, and doctors need only be licensed in one country to practice in all. In America only 21 states mandate that telemedicine be compensated at the same rate as face-to-face care. At the federal level, the Veterans Administration has embraced telemedicine whereas Medicare, largely ignores it. But private employers and insurers are increasingly paying for telemedicine.

Some small countries are forerunners.  Israel’s health-care system is fully digitized;  all doctors use electronic medical records and patients have access to their data; doctors can write repeat prescriptions and refer patients to specialists over the internet.  China is spending billions on health-care reform, with a focus on telemedicine.

But keen interest is no guarantee of success in any country. Telemedicine may even increase costs if it is added to old routines rather than replacing them.  Some doctors have been reluctant to embrace telemedicine fearing it may lessen their authority by making it easier for patients to see advice elsewhere.  So countries where provision is currently limited or non-existent may be quickest to move.


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