A 2015 World Bank report found that 400 million people do not have access to essential health services. In the United States, the 3rd highest health care spender in the world, nearly 30 million people lack basic health coverage. [1], [2]
Healthcare spending varies depending on country income level with low to middle income countries relying heavily on out of pocket payments for health services causing the poorest people to often forgo treatment because of the cost burden. Low to middle income people who do opt for treatment can be heavily burdened by the cost and be pushed into poverty. [3]
Healthcare spending is a general indicator of quality healthcare but not an absolute correlation. Per capita healthcare spending as measured by the World Bank in 2014 shows that Switzerland was the highest spender at $9674, the United States placed 3rd spending $9403, the OECD average was $4735, Singapore $2752, and China $420. In terms of best healthcare systems, greater efficiency not more spending allowed Sweden, Iceland, and Singapore to rank as the top systems in the world, while Switzerland only ranked 19th and the U.S. 28th. [4], [5]
Potential causes of this disparity between money spent and quality of services provided are administrative costs, extensive sometimes redundant testing, and the under use of preventive care. In the U.S. it is estimated that up to 25% of healthcare costs are spent on administration and on average they orders 3 times as many mammograms and 2.5 times more MRIs than other countries. Overall most healthcare systems tend to focus on sporadic healthcare, only offering care when patients are ill and seek treatment, whereas a greater emphasis on preventive care through the use of technology could identify and prevent more serious illnesses from occurring. [6]
Technology innovation offers accessibility and efficiency to the current healthcare system. The growth and potential size of this new market is huge; already in 2014 the American Telemedicine Association estimated that as many as 500,000 patients were going to see a doctor via webcam. Deloitte estimated that even if only 30% to 40% of office visits are replaced by e-visits that could make up a $50 to $60 billion market. [7]
Current systems contain three parts. First, patients in remote villages can use the pre-setup video devices in local medical service stations to link to the most experienced doctors in large hospitals in big cities. This saves the travel cost for both doctors and patients. Second, the patients’ diagnosis including X-ray or MRI results will be uploaded automatically to the patients’ profile in the cloud. Doctors and patients can access the medical record anytime anywhere. Third, a platform is built to link the doctors with the patients for making appointment and follow up services. The platform creates a digital marketplace where patients can view the doctors’ profiles and select the ones they want to see and make the appointment online. After the appointment, the doctors can check on the discharged patients’ condition by chatting with them on the platform, the patients can also take photos, videos or send their testing results to the doctor on the platform.
The impact of such technology is huge. Patients will save visit and travel time when they need an appointment and will therefore be more productive at work or have more free time. This benefit is even more remarkable for people who live in rural areas, in that they would be able to choose where to live without thinking about their care.
Moreover, the overall experience will be improved with the elimination of traditional waiting rooms with their “virtual” counterparts.
Finally, it is easy to store data and medical photos in the cloud and retrieve them during follow-up visits, increasing the ability of the doctors to compare and find anomalies.
Elderly people or those with weakened immune systems may be at greater risk of contracting additional illnesses when surrounded by other ill people in traditional waiting rooms. Patients with depressions or who are unable to leave their homes, might be unable to see doctors in the conventional way. “Virtual doctors” can solve both problems. [8]
In developing countries experiments have been done through IoT where health workers on the ground communicate patient’s symptoms and photographs to doctors in developed countries through an app. The doctors make their diagnosis and recommend treatment based on a list of the drugs and equipment kept in the health center in the developing country. [9]
Other stakeholders affected by this technology are doctors, who could benefit by reductions in their expenses working from home and by increasing patients’ retention rate through more personalized service. Hospitals, would also see a reduction in their fixed costs, and insurance companies could leverage the massive amount of data stored in the platform’s cloud to better calibrate their offers.
(Word count: 798 words) – Ana Lucia Buckman, Sally Guo, Simone Dutto
References:
[1] http://www.who.int/mediacentre/news/releases/2015/uhc-report/en/
[2] http://www.cnbc.com/2016/09/07/obamacare-pushes-nations-health-uninsured-rate-to-record-low.html
[4] http://data.worldbank.org/indicator/SH.XPD.PCAP?year_high_desc=true
[5] http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)31467-2.pdf
[7] http://www.webmd.com/health-insurance/news/20141010/virtual-doctor-visits#1
I believe that virtual appointments will be a strong component of how we get advice from medical professionals in the future. I am however left with two concerns:
1. Online doctor’s appointments require a strong internet connection with a VERY clear visual image. This still poses a problem in developed and urbanised places – How will we even come close to achieving the quality necessary in more remote areas of the world?
2. Personal interaction is vital when it comes to a doctor – patient interaction. Symptoms are such complex things that patients themselves may not have realised that they even are a symptom. It is up to the medical professional to pick up on these. These can often be nuances and as we know from interviewing via Skype, etc. a lot of these nuances can be lost in translation. In addition, diagnosing a patient is not just a visual task. Touch and possibly even smell (e.g. lumps under the skin, are they solid or soft, metallic breath) can give the doctor a lot of information that the patient may not be aware of or cannot correctly describe. How will visual doctor’s appointments compensate for that?
A very well written piece. There is no doubt on the usefulness and efficacy of having ‘virtual doctors’, however I share the same concerns as Annika above.
Atleast as of now, most remote parts of the world do not have such robust infrastructure in place to support such a technology. Further, the 2 target segments – people living in remote areas and the elderly – that can benefit the most from this technology are also unfortunately the ones that are technologically most challenged as they have little or no knowledge generally to operate smart phones or laptops and in a lot of cases might not even possess them .
Finally, as also mentioned by Annika, for most kinds of illnesses one may need to physically visit a doctor physically.
Thus, while I believe in the merit of this technology I am a little sceptical about its practical implementation.
Another interesting trend in this area is the development of low-cost, portable machinery like MRI scanners. This makes it affordable for smaller hospitals to have this technology and the reports can then be uploaded to the cloud for the expert doctors in Metros to verify and diagnose. Affordable healthcare is becoming more and more crucial.
I agree with concerns raised by Nidhi and Annika and have done some analysis for implementing this technology in rural areas. I suggest partnering with Govt. (though this in itself is a big challenge) and on-boarding Primary healthcare center and Govt. Schools in this initiative. The nurses, teachers and Govt officials in remote areas can be trained on the usage of technology and can help patients to book an appointment, connect with doctors and understand the e-prescription given by the doctors.
This is a very interesting article. It changes the conventional way of patients going to hospitals and this works best for areas that are inaccessible. I would have liked to see the risks involved in this type of technology. For example the poorest of poor live in provinces without paved roads and these communities may not have access to internet to be able to contact doctors in real time. There are also huge risks of misdiagnosis which may lead to a lot of legal claims on the doctors end. Overall the article was very informative and the idea should further be developed.
Amazing article! Could definitely see how virtual doctors can help the poor, especially in rural areas. Better matching supply and demand can increase efficiency. However, in some areas, there is a shortage of supply of doctors, so I was also wondering if AI can also play a role in this area in the future.
Virtual healthcare poses major opportunities for increasing access to life enhancing health information in developing economies, and it will certainly be exciting to see how the space develops in the coming years. I thought that one point that you raised was particularly interesting, namely that healthcare is expensive in the United States given that medical practitioners do more tests on patients. I believe that this phenomenon might be as a result of a fear of legal liability on the part of doctors and hospitals. Do you think digital innovations in the healthcare space will alleviate these issues, or do you think that there may be more legal risks associated with providing online medical advice? In the case that there are risks, how do you think that regulation could be amended or public opinion could be affected, for example, to increase the utilization and the effectiveness of digital innovation in health care in countries like the United States?
These are some really good points. Healthcare in the US is really problematic and it would really take a combination of initiatives like this one to improve it. I agree that the legal liability is a huge issue and a constraint but I believe the value that such platform could potentially provide is data. Data on patients and their medical history could also be part of this platform that could help doctor’s make smarter choices in the patients they see and the type of treatment they give. I believe this can have an impact on the overall quality of treatment and the success rate, which will help them avoid the legal liability.
I agree with the concerns of Two cents of Tim and Mumu. Often the poorest people do not have access to the internet from their homes. If, to get connection, they go to their local internet cafe, they would be exposed to long journey times, and possible exhaustion – especially if the internet cafe is not located in a convenient distance from their homes.
very interesting. In the field of preventive healthcare, there is also an increased use of cellphone. Patient can receive personalized advice or information via text.
There is the example of one project in Peru, financed by the Inter-American Development Bank. The idea is to use text messaging via mobile phones to enhance the health of pregnant women by enabling them to receive customized advice on nutrition and potential problems during pregnancy.
This is an amazing advancement to spread care to a wider portion of the global population. When we consider all the stakeholders, however, how are the current systems and caregivers (e.g. doctors, nurses) impacted in the process? Are there safeguards to ensure that there is a transition period, given that technology can spread like wildfire?
One particular addition to this proposed solution might be a blended model where an attendant actually physically takes some vital measurements and explains the prescription to the patient. The specialist doctor dials into this physical room via the webcam as you described. This will make for a more personal customer experience and breed trust.