Government Policy
From Capsil Wiki
Introduction
Telemedicine can be defined as a delivery of healthcare services through the use of Information and Communication Technologies (ICT) in a situation where the participants are not at the same location. The participants can either be two health care professionals (e.g. teleradiology, telesurgery) or a health care professional and a patient (e.g. telemonitoring of a chronically ill patient such as those with diabetes and heart conditions, telepsychiatry, etc). Literature and case studies of already-implemented or piloted telemedicine applications (including many EU-funded projects) report benefits at different levels. For example, disease management through telemonitoring of heart conditions reduces mortality rates by an estimated 20%. Savings estimates due to telemonitoring of patients who would otherwise be kept in hospitals have been shown to range between 30-60% and 40-70% of health professionals' time. The global market for telemedicine, could increase from €4.7 billion today to over €11.2 billion by 2012, an average annual growth rate of 19%. In the context of an ageing population, increased burden of chronic diseases, active participation of more demanding patients and ever increasing health expenditures, the realisation and amplification of telemedicine services is important and urgent.
However a number of barriers currently limit the deployment of telemedicine solutions to the general population and it is imperative that these barriers be removed before the real revolution of telemedicine and in particular home monitoring solutions take off.
As with other technology deployments (e.g. broadband), Government policy and intervention is key to the widespread proliferation and realisation of the full societal benefits. Government's job is to ensure that access to beneficial technologies such as home monitoring solutions are accessible to all (not just the privileged) and that it is affordable and reliable. Technology companies can bring products to the table and these can work well, however without coherent national policy regarding its use, efficiacy, privacy, security and ethics and legal regulation, the technology may well sit on a shelf and never see its true potential. This is the crucial role that government can play and it is imperative that they do get involved and not leave it to private stakeholders.
Barriers to Telehealth Adoption Where Government Policy Can Help
Cost and Reimbursement
The lack of cost and reimbursement policies have a major negative influence on the adoption adoption of home health solutions [1]. Further details can be found in the Cost and Reimbursement section.
Situation In the US
In the US, reimbursement is on a Fee-for-service basis. That is to say the actual consultation allowed must be specified exactly (a scheduled consultation just in the face to face model) or remibursement will not be possible. The Consultation codes that will be used in a billing system (and ultimately appear as a HL7 message, see CAPSIL on Standards) differ from state to state. This can lead to interoperability problems if a pan-national solution is to be put in to place. Also it complicates affairs if a teleconsultation is sought in a state out side of the state where the person resides (which codes to use?). Further detail on Healthcare Reimbursement in the USA.
Situation in Europe
See Wiki section on Business Models for more information on the European situation on a country by country basis.
In Europe the picture is very fragmented with small scale pilots being the order of the day and little or no reimbursement policies or joined up thinking across countries. Further detail is available on the European Reimbursement Situation page.
Situation in Japan
In Japan, the National Health Plan of Japan is available to all citizens, as well as documented foreigners living in Japan. Unless they join a plan offered by their employer, all are required by law to join. This results in relatively low monthly premiums, when compared to other countries. The National Health Plan provides coverage for 70% of all medical expenses except for medical checkups, cosmetic surgery, childbirth, and traffic accidents. Additionally, telehealth/telecare services are also covered under the Nursing Care Insurance Law to people over the age of 65 requiring constant care and to those between the age of 40 and 64 who suffer from certain ailments, such as dementia. However, which services are covered is decided at the prefectural and city level, and is dependent on funding as well as the services perceived utility.
Demonstrating the Benefits - Large Scale Pilots
Very generally we can say that there are two main benefits to be derived from telehealth monitoring;
- Personal and Societal Health and Wellbeing benefits
- Financial return for health services (public and private) and individuals (assuming reimbursement policies are in place).
A major obstacle towards widespread proliferation of telehealth services is the lack of hard data to indicate the business case.
What is needed to demonstrate both these aspects are large scale (ideally national scale) pilots that calculate precisely the Return of Investment (ROI) data based on these two tenets. For the reasons specified here (legal, privacy, cost etc) organisations are not willing to move forward with large scale pilots and so efforts tend to be 'sandboxed' and locked-down, fragmented efforts. Government can help here. They can make a landscape 'safe' from a legal perspective which removes a major hurlde to participation from the medical profession. They can also incentivise individuals to participate through cost reimbursement schemes such as tax-breaks, and finally they can fund significant portions of the pilot, which takes some pressure off industry having to shoulder all the cost. Further, if the government manages the administration of such a pilot and works through standard procurement processes, the process can be seen to be open, fair and transparent i.e. no favours given to any one technology or healthcare provider. This can be important in winning the public perception that this is not just another commercial push, but one that can genuinely benefit ordinary people. An excellent example of such a pilot scheme is detailed here [2], where during the summer of 2009 in the UK areas of Kent, Newham and Cornwall (which cover more than a million people between them) will be installed telecare and telehealth devices in around 7,000 homes, to assess the impact of assistive technology both on people’s lives and on the cost of providing care and support.
Data Ownership and Legal Concerns
A major issue in the uptake of home healthcare monitoring is that of policy variation between state and country (even sometimes at county level). Take an example of a person is being monitored in France and the clinician residing in Germany; then the question arises – “which country’s law is responsible for the integrity of the consultation (accurate, secure, private etc)? Where is the accountability and where is the enforcement if this contract is breached? “.
The question of data ownership and jurisdiction (i.e. where is the medicine actually being practised ?) needs to be addressed worldwide. For example within the USA with the current licensing policies, it is impossible for a patient to seek care from a physician that does not practice in the patient’s state. According to the Office for the Advancement of Telehealth (OAT) [3] “A patient in Oregon could not be treated remotely by a New York doctor, even if that physician were the country’s foremost expert on the patient’s disease.” “This is detrimental to the patient’s health because the individual might not receive the best care possible”, and according to Intel’s Eric Dishman, “it hinders telemedicine”
Perception and Attitudes
There exists a ‘digital divide’ between people aged 38 to 59 and people over 60 years of age in their attitude and confidence using technology. This is a statement that not only applies to the field of healthcare but to technology in general. However in the field of healthcare, being a primal concern for most people, this divide is most pronounced. These psychological barriers need to be addressed if home health monitoring of seniors is to maximise its potential societal benefit. Issues such as proper (user friendly and intuitive) design of systems, guaranteed security features, personal health records and privacy legislation can help this cause greatly.
Research findings suggest that the use of remote home health monitoring equipment can lead to certain apprehensions in older patients who want to sustain their personal relationships with family and doctors. Older patients may also resist using home health care monitoring services to avoid ceding authority to their adult children. Some fears held by older adults are possibly a response to societal “ageism.” Society stigmatizes signs of aging and weakness, which some older patients feel are enhanced through the public use of monitors. Another issue for older people will be the elimination of face-to-face care and this may create a perception that there will be a reduction of social interaction in the older person’s life.
The lack of motivation in older people to use telemedicine in the home often stems from an inability to understand how the technology will benefit them and make dramatic improvements in the quality of their life. It has been suggested that one reason for this is that they are “present-oriented” and less willing to spend their time in an unpleasant way for a future goal. The technology also needs to be user friendly and practical. How to set it up and use it must be almost transparent to the person’s daily routine, and finally the cost and reimbursement issues must be almost pervasive in nature and require very little beaurocracy and set up/sustaining time.
Privacy, Security and Ethics
Home healthcare monitoring poses the fundamental problems of security and privacy balanced with safe and effective healthcare. In reality these can be two opposing ideas as the more effective the home healthcare package, the more threat to privacy that exists. A full treatment of the issues is given in the Privacy, Security and Ethics page.
Broadband Proliferation
Broadband access technology of whatever type (DSL, WiMAX, Satellite etc) is a key enabler technology for home healthcare monitoring, particularly if personal health records are to be employed. The three important points in discussing broadband are Coverage, Speed and Cost. These are dealt with in detail in the Broadband Proliferation page.
How Organisations Attempt to Influence Public Policy
According to the US Government web site [4] organizations and institutions attempt to influence policy and public opinion in a variety of ways:
- Educating public officials and their staffs about the positive or negative effects of policy proposals
- Conducting advertising campaigns and public relations initiatives supporting their views
- Arranging for expert opinions and providing facts, data and opinion polls to support their positions
- Encouraging their members to vote, communicate with their elected officials and write letters to the media supporting their positions;
- Forming political action committees to contribute money to the campaigns of candidates who support their positions.
Groups such as Special Interest Groups, Non Governmental Organisations, Public Policy Associations and Trade Associations as well as individual businesses all work to influence government policy through various means. Further detail on these organisations and the methods they use can be found on the How Organisations Attempt to Influence Public Policy page.
Government Intervention
Government Intervention happens when a government takes a direct role in the enhancement of economic efficiency by addressing problems with the operation of markets and institutions or the achievement of a social objective, such as promoting equity and wellbeing.
Various governments will have their own definitions around when intervention is appropriate however a fairly representative example of Government intervention policy in the developed world would be the UK Government which uses The HM Treasury Green Book [5] to identify when it will intervene. See the UK Government Intervention Page for full details.
Notable Examples of Government Policy and Intervention for Societal Benefit
Two good examples of where governments have intervened directly for greater societal benefit include;
References
- ↑ http://www.americantelemed.org/i4a/pages/index.cfm?pageID=3334
- ↑ http://www.ehealtheurope.net/comment_and_analysis/278/2008:_the_year_telecare_grows_up_tcq
- ↑ Kumekawa, Joanne K. (September 30, 2001) “Health Information Privacy Protection: Crisis or Common Sense?" Online Journal of Issues in Nursing. Vol. #6 No. #3
- ↑ http://www.america.gov
- ↑ http://interactive.cabinetoffice.gov.uk/strategy/survivalguide/skills/ao_rationale.htm
- Back to Main Page
