Let go or limit? Policy balance of telemedicine

Source: healthpoint / Zhao Heng 2015-05-12 telemedicine has developed for many years, but the U.S market has achieved great development in the past few years, mainly because the payer supports the development of telemedicine which is superior in price due to the power of fee control However, policy makers still hold a more cautious attitude in defining telemedicine For example, Medicare only supports B-C remote consultation in suburbs and rural areas, which is strictly prohibited in urban areas But with the push of value care, Medicare may announce that it will allow B-C remote consultation completely this year However, administrative and legislative bodies in different states have different attitudes towards telemedicine For example, the Texas Medical Board recently issued a law banning doctors from remotely prescribing new patients who have not met before And in California, it's legal The Texas practice led to a lawsuit by teladoc, a Texas based telemedicine company Specifically, the Texas Medical Commission's ban is only for those users who do not establish a doctor-patient relationship before remote consultation, which is mainly for the safety of diagnosis and treatment The explosive growth of remote consultation in the United States is mainly due to the consultation of minor and chronic diseases Therefore, the ban is mainly aimed at the common cold and fever users, not the chronic disease users However, minor illness is the most important source of remote diagnosis, and it is also the core of the strange remote diagnosis mode of teladoc, so it has been hit hard In the context of cost control, how to clearly define and find the policy balance point of telemedicine is the key If all diseases are allowed to have strange remote consultation, doctors will have a lot of uncertainties under the premise of not knowing the patients very well However, it is difficult to define what kind of disease can't be diagnosed remotely in policy Therefore, relatively conservative policy makers will strictly limit the scope of remote consultation But in terms of common sense, doctors in the United States have learned to protect themselves In uncertain circumstances, they will not rush to give diagnosis opinions, but will ask patients to go to offline medical institutions Therefore, in general, the full liberalization of remote consultation will not lead to serious security problems in the United States Although there are many companies entering telemedicine in China, they also attract the attention of the market However, due to the particularity of China's medical system, the development of remote consultation in China is not likely to break out However, the government's restrictions on telemedicine have not changed in any way It still requires that it can only be implemented between medical institutions From the perspective of China's national conditions, the policies of the health and family planning commission are reasonable First of all, China's telemedicine is more profit-seeking than fee control Due to the long-term distortion of the price of medical services in China, the offline consultation fee is relatively low, while the online consultation fee is very high In this case, the users of telemedicine are mainly the patients with difficult and miscellaneous diseases, and they want to get the services of famous doctors more It is doomed that the user base of telemedicine is very narrow, and the motivation of doctor service is more to make money However, for famous doctors, they are not short of money, so the willingness of online services is not strong But ordinary doctors are the main force of online consultation, but their ability to deal with difficult and miscellaneous diseases is insufficient Before these core contradictions can not be solved, it is necessary to limit the distance, because the mismatch between supply and demand can easily lead to disputes and damage the interests of patients Secondly, there is a lack of charging standards and service standards for diagnosis and treatment in China Due to the extensive management of medical insurance for a long time, the payment standards of medical insurance in China are not unified in the whole country, especially there is no standardized payment system for all kinds of diseases At the same time, the service ability of medical institutions is extremely low, and there is not a complete set of service system in the process of serving patients The above two points seriously restrict the offline medical services Once we want to use the existing medical services for online services, this drawback is very obvious Different from the United States' standardized telemedicine, China's current telemedicine and so-called Internet consulting market is very chaotic In such a situation, not only the patients are at a loss, but also the supervisors are difficult to make standardized management Finally, the relationship between doctors and patients in China is tense and the legal boundary is vague For a long time, the doctor-patient relationship in China has been very tense due to the influence of difficult and expensive medical treatment The source of tension between doctors and patients is patients' distrust of doctors, and the source of distrust is the system of supporting doctors with drugs It is impossible for doctors to diagnose and treat patients from a more objective point of view, which ultimately damages their own image But the root of this system is not the doctors themselves, but the problems of the medical system Therefore, on the premise that the medical reform does not touch the core areas of reform, it is difficult to ease the tension between doctors and patients In this context, remote consultation is more likely to produce all kinds of disputes, which leads to market disorder Therefore, even if the policy makers partially liberalize the restrictions of telemedicine in a short period of time, there will be many problems caused by the confusion of the market, and the final damage will still be the patients and the whole medical insurance payment system In order to promote telemedicine to benefit the public as soon as possible, what the government should do is to improve the offline medical insurance system as soon as possible, strengthen the fine management and fee control mechanism of medical insurance, and try to establish a set of diagnosis and treatment standards and service standard system, so as to effectively supervise the online and offline overall medical services through this system The policy balance point of telemedicine in China depends more on the reform of offline system If the progress of offline system reform is slow, it will greatly affect the development of telemedicine in China Even if policy makers are no longer conservative, telemedicine can hardly achieve real development Therefore, the development of telemedicine in China still needs the government to really promote medical reform, so as to usher in the possibility of explosive growth of the market.