Obstacles Remain for Telemedicine, Even After Increased Use During Coronavirus Outbreak
On Friday, President Trump announced the loosening of federal restrictions on the use of telemedicine in the US. He described telemedicine as "a fairly new and incredible thing." He's exactly right. It's only fairly new. The most basic form of the technology has been around for over a decade. So, why wasn't telemedicine adopted sooner?
One in 10 Americans have used telemedicine services, and one in four are aware of it and have access, according to a 2019 J.D. Power study. At a time when online communication is so commonplace, it's surprising that these numbers are so low. The coronavirus outbreak, however, is increasing the use of telemedicine consultations. Teladoc, an American telemedicine provider, saw a 50% increase in virtual medical visits last week.
It makes sense that people would avoid going to see a doctor in person during the COVID-19 outbreak. Governments around the world are encouraging their citizens to avoid contact with others as much as possible, whether they are sick or not. But in the US, the boost is also due to lower cost and increased availability, in part due to the changes that President Trump announced on Friday. For example, some doctors can now consult patients in different states. Many patients will also pay less for telemedicine visits than they would for in-person visits.
This mix of social and regulatory factors points to many of the reasons telemedicine is still so rarely used. Health systems, for the most part, don't incentivize its use. Patients aren't used to it, so they prefer the mode of care they know best: in-person visits. In systems that have developed and encouraged telemedicine, such as Kaiser Permanente in the US, the results are much better. As early as 2015, Kaiser Permanente reported that over half of its 110 million patient interactions were e-visits of some kind.
One would hope that the changes motivated by the COVID-19 outbreak will stick. Maybe we're finally getting closer to the dream promised by telemedicine: healthcare that is more efficient, more effective, and available to more people.
However, we don't yet know if any of the regulatory changes will be permanent. Health systems are large and heavily-regulated beasts. The inertia of large public and private systems will likely slow down the adoption of telemedicine, even after a crisis response like we're seeing now.