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
By: Anca Cotet (Department of Economics, Ball State University)
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.