Cost Factors in Urban Telemedicine : Medical Care (original) (raw)
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Muller, Charlotte Ph.D.1; Marshall, Cahter L. M.D.; Krasner, Melvin; Cunningham, Nicholas M.D.2; Wallerstein, Edward; Thomstad, Beatrice2
1From the Graduate Center, Mount Sinai School of Medicine of the City University of New York
2From the Department of Community Medicine, Mount Sinai School of Medicine of the City University of New York
Abstract
This paper reports on the cost effectiveness of a pediatric primary care system utilizing nurse practitioners (NPs) linked to a physician consultant through bidirectional interactive cable television. In addition, it discusses ways in which multiple uses enhance the economic feasibility of a telemedicine consultation link in a given geographic area. The overall consultation rate during periods of remote physician coverage was 21 per cent, compared with 24 per cent during on-site coverage. The telephone became a partial substitute for the TV for some uses but could not replace it in diagnostic decisions.
As telemedicine is obviously underutilized in a one-satellite system, we compare a five-satellite network with other ways of delivering service. The resulting estimated cost of 18.50anhour,or2/3ofthecostofaphysicianprovidingdirectcare,includesaTVcomponentof18.50 an hour, or 2/3 of the cost of a physician providing direct care, includes a TV component of 18.50anhour,or2/3ofthecostofaphysicianprovidingdirectcare,includesaTVcomponentof5.30 an hour of use in a 1,750-hour year. The critical factor is that the NP can be a physician substitute if there is TV backup. The TV appears to prevent unnecessary referrals compared to a physician on site. Whether TV increases the length of the consult compared to the phone for conditions of equal severity is not entirely clear.
If TV is compared to transporting a patient to a central place, the implicit value of transport time and disutility required to justify using TV is $7.55 per consult in a five-clinic network.
Geographic and other barriers to physician availability enhance the potential for application of telemedicine.
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