Telemedicine and medical insurance

By Claire Mahoney

The European Health Telematics Association's (EHTEL) white paper and action plan for 2002-2003 states that without the creation of reimbursement processes and a regulatory framework for healthcare telematics the market for such devices will never grow.

EHTEL’s research shows that in most countries where healthcare is not state-funded  there is no reimbursement process for telemedicine.

A recent study published in the British Medical Journal that looked at 600 cost-related articles on telemedicine found that only 9% contained any cost benefit data and only 4% met the quality criteria set for the review.

Benedict Stanberry, telemedicine consultant and chair of the European Health Telematics Association’s (EHTEL) says that, even though there is a huge body of academic research on the subject, many papers tend to focus on small-scale, localised pilot studies, and are not placed in a wider context to see what the benefits, such as cost-effectiveness, could be. ‘A lot of these articles wouldn’t really pass muster with a qualified health economist,’ he points out. ‘The trouble is the champions of the technology tend to be blinkered and don’t present telemedicine in a balanced way. There is a lot of talk about telemedicine that is technology-led and it needs to be clinically-led.’

Research The European Commission (EC) is trying to help by funding research that carries a convincing business argument. As part of its Sixth Framework Programme for research the EC is ploughing some 3.6 billion euros into Information Society Technologies.

Andreas Lymberis, Scientific Officer in the Applications Relating to Health unit of the Commission’s Information Society Directorate-General, says: ‘What we are trying to do is develop a methodology that will assess the quality, cost-effectiveness and accuracy of care in these projects.’
EHTEL is hoping to highlight successful applications by putting together a matrix analysis of telemedicine which not only gives an overview of the issues but also shows applications where telemedicine is not necessarily appropriate. ‘Telemedicine needs to be presented to insurers in a balanced way,’  Benedict Stanberry points out. This balanced and practical approach is also a crucial factor when presenting arguments for the technology to healthcare professionals. ‘In a great many countries, and certainly in Europe, telemedicine threatens to upset referral patterns that doctors have spent a lifetime building up.’

Research problems
The trouble with telemedicine is that it is like a moving target and as the technology develops the scope for implementation in healthcare becomes much broader,’ says Andreas Lymberis.
Axel Baccari, healthcare analyst at the European market research company Frost and Sullivan, agrees: ‘Telemedicine is a so-called diffuse technology, in other words it is not limited to a specific area.’

Successful applications
Telemedicine applications are being developed in areas ranging from dermatology to pathology. In home care, video consultation and mobile monitoring devices can reduce lengths of hospital stays, while still maintaining care.

A recent study undertaken at Aristotle University in northern Greece used multi-media cardiac monitoring equipment that, on average, reduced hospital stays by 60%.
Telemedicine has proved vital in countries where distance and remote areas make traditional methods of healthcare delivery very difficult.

UK company Motion-media has taken part in a project in Australia that uses videophones to send video and data signals to a Mobile Intensive Care Ambulance (MICA) paramedic or emergency department specialist, based hundreds of miles away. The satellite videophone can be connected to a range of medical devices, such as electrocardiograms, vital signs equipment, and digital stethoscopes.

The future for Europe
Some commentators predict that the general strain on European health services may end up forcing insurers to open up to telemedicine and e-health.
Last year’s European Court of Justice judgements, which ruled that patients need not obtain pre-authorisation from their health insurance companies for cross-border care, may help as well.
Herve Doare, EHTEL’s executive director, says, ‘The healthcare insurance companies will stick as long as possible to their current position. But cross-border care is a challenge for them - it is a cultural revolution as it means that for the first time they will have to be competitive.’

*This feature (published with the permission of Campden Publishing, London) first appeared on the Hospital Forum website: www.hospitalhealthcare.com

30.04.2003

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