Cost Analysis in Telemedicine: Empirical Evidence From Sites in Arizona

Study of awareness, adoption and experience of telemedicine technology services; perspectives during coronavirus (COVID-19) pandemic crisis and associated economic lockdown in India

Purpose

The purpose of this paper is to study the phenomenon of abrupt shift by both doctors and patients to telemedicine during the coronavirus (COVID-19) pandemic and associated economic lockdown in India. The study explored various drivers of telemedicine technology awareness, adoption and usage. These drives were studied from both the doctors and the patients’ perspectives using the Push–Pull–Mooring (PPM) theoretical model.

Design/methodology/approach

An exploratory qualitative research was carried out with 24 doctors and 32 patients. This research was conducted in major urban cities of India. It was carried out during the economic lockdown due to the COVID-19 pandemic. The data was collected based upon a semi-structured open-ended questionnaire using telephonic interviews. Once thematic saturation was achieved, thematic content analysis was conducted. Finally, the themes were classified and analyzed using the PPM theoretical model

Findings

The data analysis indicated that there was the presence of all three factors, namely, push, pull and mooring. For the doctors, pull and push factors were more substantive than mooring factors. Although for the patients push and mooring factors were more important and pressing than pull factors.

Research limitations/implications

This study was conducted during the COVID-19 pandemic and associated economic lockdown in India. The interview respondents were located only in urban India. Future studies could be conducted to explore similarities and differences in telemedicine adoption patterns during non-crisis times vis-a-vis crisis times in urban and rural settings.

Practical implications

The insights from this study could be used by medical service providers to leverage telemedicine technology to improve the business model, service delivery, pricing strategy, value proposition and behavioral characteristics. Patients on the other hand could gather perspectives regarding how best to use telemedicine technological services.

Originality/value

The authors provided an integrated perspective regarding telemedicine technology awareness, adoption and usage in an emerging economy of India during the critical times of the COVID-19 pandemic crisis and the associated prolonged economic lockdown. This was one of the first studies that applied PPM theory for telemedicine adoption

Assessment of Utilization and Cost-Effectiveness of Telemedicine Program in Western Regions of China: A 12-Year Study of 249 Hospitals Across 112 Cities

BACKGROUND

The imbalance in healthcare between urban and rural areas is still a problem in China. In recent decades, China has aimed to develop telemedicine. We assessed the implementation, utilization, and cost-effectiveness of a large telemedicine program across western China.

MATERIALS AND METHODS

In 2002-2013, a government-sponsored major telemedicine program was established by West China Hospital of Sichuan University (hub), covering 249 spoke hospitals in 112 cities throughout western China and in 40 medical expertise areas. We analyzed the cross-sectional data from 11,987 consultations conducted at West China Hospital using the telemedicine network over a 12-year period. The types of diseases as well as the diagnosis and treatment changes were assessed. We also performed a cost-savings analysis and a one-way sensitivity analysis.

RESULTS

Of the 11,987 teleconsultations, we noted that neoplasms (19.4%), injuries (13.9%), and circulatory diseases (10.3%) were the three most common diagnoses. Teleconsultations resulted in a change of diagnosis in 4,772 (39.8%) patients, and 3,707 (77.7%) of them underwent major diagnosis changes. Moreover, it led to a change of treatment in 6,591 (55.0%) patients, including 3,677 (55.8%) changes not linked to diagnosis changes. The telemedicine network resulted in an estimated net saving of $2,364,525 (if the patients traveled to the hub) or $3,759,014 (if the specialists traveled to the spoke hospitals).

CONCLUSIONS

The introduction of telemedicine in China, linking highly specialized major hospitals (hub) with hundreds of small rural hospitals (spoke), can greatly improve the quality, efficiency, and cost-effectiveness of healthcare delivery and utilization. This new Internet-based healthcare model should be utilized more widely in developing countries.

Telemedicine in an international context: definition, use, and future

PURPOSE

Use of telemedicine is increasingly prevalent in order to provide better access to expert care, and we examine telemedicine use internationally.

DESIGN/METHODOLOGY

Using Donabedian's structure, process outcome framework, we conduct an analysis of published studies in the United States, Europe, and Asia to examine the uses, conditions treated, barriers, and future of telemedicine.

FINDINGS

We identify several similarities and challenges to telemedicine use in each region. We find use of videoconferencing between providers or providers and patients for the treatment of acute and chronic conditions. Studies in the United States are more likely to identify applications for the use of chronic conditions, whereas studies in Europe or Asia are more likely to use them for acute access to expertise. Each region reported comparable challenges in reimbursement, liability, technology, and provider licensing.

RESEARCH LIMITATIONS

We compare available research articles from three diverse regions, and many of the articles were merely descriptive in nature. Furthermore, the number of articles per region varied.

PRACTICAL IMPLICATIONS

Barriers to telemedicine use include a lack of reimbursement, language commonality, technological availability, physician licensure or credentialing, trained support staff and patient privacy, and security assurances. Practitioners and policy makers should work to address these barriers.

ORIGINALITY/VALUE

Through this work, a summary of the research to date describes telemedicine use in the United States, Asia, and Europe. Identification of use and barriers may provide impetus for improving access to care by finding ways to increase telemedicine use through standardization.

Beyond the horizon: the role of academic health centers in improving the health of rural communities

Academic health centers (AHCs) face increasing pressures from federal, state, and community stakeholders to fulfill their social missions to the communities they serve. Yet, in the 21st century, rural communities in the United States face an array of health care problems, including a shortage of physicians, health problems that disproportionately affect rural populations, a need to improve quality of care, and health disparities related to disproportionate levels of poverty and shifting demographics. AHCs have a key role to play in addressing these issues. AHCs can increase physician supply by targeting their admissions policies and educational programs. Specific health concerns of rural populations can be further addressed through increased use of telemedicine consultations. By partnering with providers in rural areas and through the use of innovative technologies, AHCs can help rural providers increase the quality of care. Partnerships with rural communities provide opportunities for participatory research to address health disparities. In addition, collaboration between AHCs, regional planning agencies, and rural communities can lead to mutually beneficial outcomes. At a time when many AHCs are operating in an environment with dwindling resources, it is even more critical for AHCs to build creative partnerships to help meet the needs of their regional communities.