In many countries, telemedicine is playing an important role in COVID-19 pandemic response and may have an increased role in non-COVID-19 service delivery going forward. Join us for a webinar discussion of telemedicine in the three largest countries of the world–China, India, and the United States. Panelists will discuss the policies around insurance coverage, pricing, and quality of telemedicine and the role that telemedicine may have in the regular health care delivery system for years to come.
Panelists
- Hongqiao Fu, Assistant Professor in Health Economics and Policy in School of Public Health, Peking University
- Ajay Nair, Co-founder, MeraDoctor
- Ateev Mehrotra, Associate Professor of Health Care Policy, Harvard Medical School
- Moderator: Winnie Chi-Man Yip, Professor of Global Health Policy and Economics, Harvard School of Public Health; Director, Harvard China Health Partnership; Interim Director, Fairbank Center for Chinese Studies.
Sponsored by the Fairbank Center for Chinese Studies and Harvard China Health Partnership. Co-sponsored by the Mittal South Asia Institute and the Harvard University Asia Center. This panel discussion is presented as part of “24 Hours of Harvard,” a special feature of Worldwide Week at Harvard 2020.
Summary
- CHINA. Before 2018, China had no explicit policies for telemedicine, but the pandemic and related shutdown accelerated the expansion of telemedicine. Demand for online healthcare services has increased, as has the supply of doctors who are willing to serve online. Investors are optimistic about the future of telemedicine and the government is creating a more friendly policy environment to support its growth. Looking into the future, we can expect a) regulation on the quality of telemedicine services as well as b) continued competition between private commercial platforms and public hospitals. For example, in terms of dual practice, the data suggests that the more senior a (public) physician is, the more they are active in providing private telemedicine consultations in their off hours. Future policies will also likely address c) price, affordability, and equality—how and who will set the prices, and how will that interact with social health insurance? Lastly, d) how will telemedicine affect the tiered health delivery system and crowding of tertiary hospitals—will it exaggerate the crowdedness, or contribute to more effective triage?
- INDIA. India had some experience with telemedicine before the COVID-19 pandemic, such as tele-consultations for mostly public doctors to consult with specialists; and, in 2016, the mushrooming of consumer applications for remote consultation with private doctors. As a result, when facility-based consultations declined drastically during the pandemic, telemedicine service volume surged for both public and private services, across many specialties, even including tele-ICUs in multiple states for remote monitoring of patients. The policy environment has supported the growth, with the issuing of telemedicine practice guidelines (March 2020) and the shift of allowing insurance reimbursement (September 2020). Clinical standards are evolving as a private initiative. The experience of digital health and telemedicine during the COVID-19 pandemic has the potential to help the Indian health system in several different ways. Digital technology can help reorient the delivery model to more preventative and promotive health care, and address regional disparities in access for remote locations; continuity of care can be encouraged by networking providers; quality improvement can be integrated; incentives can be better aligned away from fee-for-service models towards health outcomes; and financing can be tailored to support health needs.
- UNITED STATES. Similar to many other countries, the United States experienced a drastic reduction in in-person visits at the onset of the COVID-19 pandemic. As the economy has re-opened, visits have rebounded to approximately 10 percent below baseline, and the use of telemedicine has plateaued at approximately 7 percent of all visits. Debate persists about whether use of telemedicine will widen disparities in care. Several key challenges remain. a) The uncertainty of long-term payment and regulatory plans has deterred investments by providers. b) Though telemedicine has been crucial to maintaining care during the pandemic, government and health insurers may be leery of covering telemedicine visits permanently. c) One key strength of telemedicine is its convenience, which could also be viewed as its greatest weakness—will it result in an overuse of care? From the policy side, a) there is a recognition that not all telemedicine modalities are the same. b) How do we tailor telemedicine policy for proper application to different conditions and specialties? c) Providers report confusion over the recent rapid changes and so there is a need for simplicity. d) How do we address overuse? Do we limit choices at all by patient, condition, or provider? e) How should the relative cost differences be addressed between in-person and remote visits?
Resources
- A recording of the discussion is available here (select Part 2 and then fast forward to time stamp 3:31:20).