Telehealth as Gatekeeper: Policy Implications for Geography and Scope of Services

Abstract

Why, despite enthusiasm, is telehealth still a relatively minor part of healthcare delivery in many health systems? We examined two less-considered policy issues: (1) the scope of services being offered by telehealth and how this matches existing arrangements for insured services; and (2) how the ability of telehealth services to minimize barriers associated with geography is dealt with in a system organized and financed on geographical boundaries. Fifty-three semistructured interviews with key stakeholders involved in the management of 43 Canadian telehealth programs were conducted. In addition, quantitative activity data were analyzed from 33 telehealth programs. Two telehealth approaches emerged: telephone-based (N = 3), and video-conferencing-based (N = 40). Most programs reflected, rather than superceded, existing geographical boundaries; with the technology being used, the videoconferencing models imposed significant barriers to unfettered access by outlying communities because they required sites to acquire expensive technology, be affiliated with an existing telehealth network, and schedule visits in advance. In consequence, much activity was administrative and educational, rather than clinical, and often extended beyond the set of mandatory insured services. Despite high hopes that telehealth would improve access to care for rural/remote areas, gatekeeping inherent in certain telehealth systems imposes barriers to unfettered use by rural/remote areas, although it does facilitate other valued activities. Policy approaches are needed to promote a closer match between the expectations for telehealth and the realities reflected by many existing models.

Global E-Health Policy: A Work In Progress

“…Political power imbalances between sites further limit cross-border e-health practices. 6 At the same time, there is evidence that some regions around the world are slowly gaining ex- perience in cross-border e-health. For example, in Latin America, six countries are engaged in cross-border telehealth practices.…”

A Comparison Study of Single-Parent Families Living on Remote, Rural Islands and in Urban Settings in Japan

“…Implementing easy-to-access healthcare consultation services may offer an effective approach to maintaining and improving the health of single-parent families. These services may include telehealth services (Kraetschmer, Deber, Dick, & Jennett, 2009), e-mail message consultations (Campbell-Grossman, Hudson, Keating-Lefler, & Heusinkvelt, 2009), and Web-based mental health services (Lipman, Kenny, & Marziali, 2011). Owing to the limitations of healthcare resources and access, islanders frequently care for family members at home rather than consulting local medical services.…”

Can We Improve Adherence to Preventive Therapies for Cardiovascular Health?

“…Telehealth sessions (delivered via telephone, video, or Internet) offer a way to meet with patients who cannot attend clinic visits. Although effective, 29 telehealth is not widely implemented, 30 possibly because the cost effectiveness of this approach in reaching rural populations is equivocal 29 and because patients may lack the necessary technology. 30 The increasing popularity of voice-over-Internet Protocols (eg, Skype), which do not require specialized equipment, may reduce these barriers.…”