New economy shock! Telemedicine can improve people’s health

telemedicine

Ever rung a hospital or medical practice for advice and been told that they won’t give you advice unless you come in. For private practitioners this is partly a way of making money – they get to see not just the whites of your eyes, but the colour of your money. But the rule is also often enforced by emergency departments. Our experience with Victoria’s system of emergency medical care has been pretty good. A nice lurk if you have someone with asthma is to get the ambulance to drive you in. This is very expensive for the state, but it’s the indicated treatment when things are getting bad. You get ambulance insurance and Bob’s your uncle. Not only do you get a nice ride into hospital, but you go to the front of the queue when you arrive.

But what if it’s the middle of the night and you need some advice quick. In Victoria they refuse. In the ACT they’ll give you the advice. So we use our ACT address if we need advice over the phone and hop in the ambulance if an asthma attack means Alex needs to go to hospital (this is not very often – probably five or six times in his eleven year long life and it’s becoming much less common again).

Anyway, being refused advice on the grounds that any advice would be worse than none has always infuriated me. Providing people can be commonsensical in discussing the symptoms it seems a classic case of my presumption about information. More is almost always better than less unless you can think of a good reason why it’s not. In any event, I now have some evidence to go on. Viz:

Quantity versus Quality in Medical Care: Evidence from State Variation in Telemedicine Regulation
Date: 200902
By: Anca Cotet (Department of Economics, Ball State University)
URL: http://d.repec.org/n?u=RePEc:bsu:wpaper:200902&r=reg
This paper uses variation in state by state regulation affecting telemedicine to investigate whether the quality standards imposed by current medical regulations are too high. The Physical Examination Requirement (PER) regulation prohibits certain physician-patient telemedicine practices, expected to be of lower quality than face-to-face consultations, in order to prevent the erosion of current quality standards. At the same time however, PER makes it more difficult for some individuals to obtain professional medical advice. The empirical results suggest that states that adopted such regulation experience an increase in mortality in some sub-populations. Specifically, such . . . outcomes appear in more sparsely populated areas, in areas with low physician density in total population, for individuals earning relatively low or relatively high wages, and are more likely for infants and adults ages 24 through 65. In aggregate PER leads to an increase in infant mortality and no significant effect on other age groups, an indication that easier access to professional medical advice through telemedicine even at the cost of lower quality improves outcomes.

Note where you see the three dots above indicating words edited out, the word edited out was ‘improved’, which didn’t make any sense.  I presume it is some kind of misprint.  On a quick squiz of the paper I couldn’t find improved outcomes from bans on telemedicine.  Alternatively the word ‘improved’ refers to improvements from not banning telemedicine.

This entry was posted in Economics and public policy. Bookmark the permalink.
Subscribe
Notify of
guest
13 Comments
Oldest
Newest Most Voted
Inline Feedbacks
View all comments
NPOV
NPOV
12 years ago

Is the Nurse-On-Call service no use for that sort of thing though? We’ve used that a couple of times, and the first time they reassured us it wasn’t worth taking our then 2yo into hospital, the second they confirmed it was worth doing so (nothing serious, just needed some suturing).

basalisk
basalisk
12 years ago

I’m sorry, but I’m sick of the assumption that if you pester the ambos to give you a lift to the emergency department, you’ll get seen before the shmoes stupid enough to walk in through the door.

I’ve worked in several EDs in two different states, and they all use the same triage guidelines. Mode of arrival doesn’t factor into it. You come to the front counter with chest pain and a history of prior MIs, you will be seen before someone who came in an ambulance to get their prescription for blood pressure meds. (Don’t laugh, it happens.)

DON’T USE AN AMBULANCE BECAUSE YOU THINK YOU’LL BE SEEN FASTER. YOU WON’T.

Francis Xavier Holden
12 years ago

The need for face to face is partly to stop fraud, partly to prevent patient harm and other stuff and largely good medicine. In general it’s not good medicine to advise or prescribe without a physical or some sort.

It’s not true that telemedicine is banned in Australia. In fact there is a specific item on MBS for tele consultations, at least for psychiatry, that I’m aware of since 2005.

Theres no way arriving by ambulance makes any difference to how soon you are treated at any A&E in Australia. You will be triaged on life threatening acuity just like everyone else.

Providing people can be commonsensical in discussing the symptoms

yeah well – there’s the rub mate

Francis Xavier Holden
12 years ago

nic – I would report any A&E for malpractice of it was doing what you said without proper triage.

Francis Xavier Holden
12 years ago

nic – I would report any A&E for malpractice if it was doing what you said without proper triage.

Francis Xavier Holden
12 years ago

Perhaps theres a misunderstanding here.

Do you mean you get to triage quicker or that you get to treatment quicker?

Francis Xavier Holden
12 years ago

I’m trying to remember asthma treatment but I think that the ambos will have started something – do they start oxygen or salbutamol nebulised or corticosteroids?

If so then the hospital treatment will be a continuation of ambo intervention.

Francis Xavier Holden
12 years ago

btw my youngest has asthma – rarely bothers him now but when he was small it was frightning when acute – I know what its like to be in A&E at 3 am etc.

Then about 15 years ago all treatment improved in an amazing leap with preventatives and acute self medications nand self management.

Francis Xavier Holden
12 years ago

If you come from the ambo in having had the paddles applied to your chest etc because of heart failure then you’ll get treatment quicker – but no quicker than if you come in grey looking with pains down the left hand side driven in by a taxi.

You get treatment quicker because of acuity – ambos have some input into the triage classification. But by and of itself coming in by ambulance doesn’t get quicker treatment.

billie
billie
12 years ago

I had been wondering why Australia doesn’t have centralised electronic medical records yet. I know that the development work was done a decade ago and I knew there would be political impediments to it. Meanwhile Brazil has a medical system where a physician in Sao Paulo can access patient records from Rio De Janerio. Not sure that all Brazilians have electronic medical records as there is no universal health care there.

In rural Australia patients regularly wait 3 weeks for a medical appointment which may be for repeat prescription, medical certificate because unable to sit a university exam or attend work, or medical certificate to get subsidised taxis. Surely a nurse or pharmacist or vet with medical knowledge and integrity could certify this bureaucratic paperwork