The failure to commit money and imagination to "e-medicine" has undercut the potential of using electronic technology to deliver health-care services to the elderly and poor, a University of Illinois law researcher says.
"We have the technology; what is needed is government financial commitment," Kristen R. Jakobsen writes in the upcoming issue of the Elder Law Journal, a publication of the UI College of Law.
E-medicine (often called telemedicine) can cut as much as two-thirds of the cost of on-site care by using e-mail, faxes and telephone consultations to link patients with health-care providers. Equally important, e-medicine promises to improve access to health-delivery services in rural areas with chronic shortages of doctors and hospitals, writes Jakobsen, a graduate of the law college.
Licensing, patient consent and other issues will have to be resolved before telemedicine becomes an accepted method of delivery, according to Jakobsen. But an even greater hurdle is the federal Medicare system, which has so far resisted efforts to broaden reimbursements to include many telemedicine procedures.
"Because many elderly rely on Medicare to pay for their health-care expenses," Jakobsen wrote, "telemedicine will not provide a solution until [Congress and Medicare administrators] promulgate a suitable reimbursement scheme for this type of health-care delivery."
The Health Care Financing Administration, which runs Medicare, will not reimburse doctors who share lab results by means of fax or the Internet nor pay for phone or e-mail consultations between a doctor and patient. Instead, only "face-to-face consultations" are reimbursed, which has the effect of encouraging the most expensive type of e-medicine technology – interactive two-way video conferencing.
Such interactive video requires special T1 lines that are not only costly but exist mainly in urban areas. By contrast, faxes and e-mail can deliver images and information over regular phone lines, making them more accessible and cost-effective for rural and low-income communities.
In addition, "interactive video requires the simultaneous presence of two health-care professionals, one at either end of the consultation," Jakobsen wrote. "With the hectic schedules of physicians and other health-care professionals, this is not always convenient. On the one hand, the specialist can review 'store-and-forward' telemedicine at his or her convenience and either call or e-mail the local physician with an assessment." Attempts to lift some of the restrictions on Medicaid reimbursement have stalled in Congress. While Kansas and several other states have begun to move forward in telemedicine, the United States lags behind Canada, Europe and Japan in the use of high-tech delivery.
Telemedicine has proven especially effective in Norway where even the installation of costly equipment has proven cheaper than flying doctors into remote regions.