The Inherent Paradox of Medical Innovation: Take the American Online Consultation as an example.

Unlike the innovation of traditional industry, medical innovation has its own unique development, mainly influenced by the interests of the payer and the service providerOn the other hand, the consideration of economic, convenient and safety factors is of the utmost importance because of the individual health and interests of the userTogether, these two elements become the main driving force and constraint of medical innovationHere's a brief example of the development of digital healthcare in the United States to illustrate this challengefirst of all from the interests of the payer and the service, the remote consultation is more to meet the needs of the payer and develop, if the service provider in which to obtain more benefits, will restrict the payer to its driving forceDigital health care has come a long way since the U.Sbegan implementing the Affordable Care Act (ACA), especially with remote consultationsBecause the price of online services is lower than offline, the technological innovation represented by telematics service provider Teladoc meets the goal of pay-per-side feesThis is also the direct reason why the remote consultation is favored by the U.Scorporate self-insurance marketBut U.Smedical institutions don't buy this, they believe that the low price of remote consultations harms their own interests, so most doctors are less involvedHowever, because the value of the United States to promote the hospital readmission rate has a strict assessment, the hospital is more interested in the discharge of patients health management, which led to the development of disease management, remote monitoring has developedfrom the physical point of view, remote consultation by the non-health insurance market favor, in the enterprise self-insurance and commercial insurance market has achieved rapid development, but in the United States health insurance market development is relatively slowThat's because the U.Sfederal health care system's strict rules on remote consultations cover rural areas and areas where medical services are less accessibleAs the new crown epidemic spreads in the U.S., federal health insurance has relaxed restrictions on long-distance visits and raised the price of online consultations to the same level as offline prices to encourage doctors' participation However, if the price is consistent online and online, the remote consultation obviously can not meet the requirements of the payer control fee, after the outbreak is not able to obtain the continued support of the payer to maintain rapid development is faced with variables second, security, convenience, and out-of-pocket ratios are the main considerations from a user perspective if from the user's participation, under normal circumstances, remote consultation is not the user's first choice According to a recent study by JAMA Network, only 14 percent of users choose online consultations when an appointment is free to choose offline and online, with young women aged 18-44 choosing online consultations, while those over 65 rarely choose online consultations The study, based on Kaiser's 2016-2018 consultation data in Northern California, selected 2.18 million visits from 1.13 million users, with users choosing to see them offline or via video and phone The results showed that 86% of users still chose to go to the clinic offline Although 14 percent of users choose online, the vast majority are over the phone, and only 7 percent of online inquiries use video When users are inaccessible, the frequency of using remote consultations increases significantly, and if they have been to a previous doctor, users are more likely to adopt online visits Caesar's use is relatively high compared to Teladoc's 9 percent usage rate, mainly due to the statistical gap Since Teladoc relies heavily on membership fees, aggressive expansion of membership is the main way of its revenue, mainly compared to the number of members Caesar's data is only a comparison of all consultations, and Caesar's video consultations account for only 0.9 percent of the total number of consultations, and telephone consultations are listed as the primary means of remote consultations, which also show that technology and model innovation have little impact on the field therefore, from the perspective of the influence of the payer, want to promote the user to convert some visits into cheaper online consultations, but the user usage rate is not high, this is partly because of user security considerations, more trust offline consultations, on the other hand, economic factors According to the Kaiser study, users with higher out-of-pocket rates and deductibles tend to use online clinics, while those with lower out-of-pocket rates are more likely to opt for offline clinics This shows that online consultation in some cases is the user's helpless choice, economic factors in which play a great role and from the accessibility point of view, online consultation can really solve some of the inconvenience of transportation or due to the long commute time caused by the inconvenience of medical treatment And for those with their own family doctor, or who often visit the same doctor, online consultations are more used, suggesting that recognition of doctors is another important factor in the way users choose to consult According to a 2015 rand study of Teladoc users, because Teladoc is the main doctor's consultation, users are more likely to seek prescriptions This suggests that if you don't trust a doctor, the user's needs are only for prescriptions, not real consultation needs from the development of the American online consultation industry, mainly by the interests of the payer and service providers of the impact of the game, and the user's security, convenience and economic factors of the multi-factors also affect the development of remote consultation Therefore, the core of medical innovation to be developed is the ability to meet the overall balance of payers and service providers, while balancing users' economic and security needs As long as the interests of either side are not met, it is difficult to really push this model away But if one side gains too much and breaks the balance, medical innovation can be frustrated and unsustainable.