Sisk J E, Sanders J H
Division of Health Policy & Management, Columbia University School of Public Health, New York, NY, USA.
Telemed J. 1998 Spring;4(1):31-7. doi: 10.1089/tmj.1.1998.4.31.
Economic evaluation of telemedicine compares the costs and other consequences of delivering specific services through telemedicine vs. alternative means. Cost-effectiveness analysis, the most common method used for health issues, helps to assess whether the expected health benefits are worth the investment. Telemedicine raises particular challenges for evaluators: a telemedicine system may have multiple uses and joint costs that are difficult to apportion to one service, the existence of a system may lead to expanded indications for use, and technological change may rapidly make an evaluation outdated. Public and private regulation and payment may affect the diffusion of telemedicine. Uncertainty surrounds the policy of the U.S. Food and Drug Administration, which is still formulating its position. Changes are underway in policies on licensure and credentialing of clinicians, which have traditionally been done by state and by site, to reflect the fact that telemedicine services may cross these regional boundaries. Lack of insurance coverage for telemedicine services has been considered an impediment to adoption with fee-for-service payment. Under capitation payment and fixed budgets, however, providers have financial incentives to use the most efficient method to deliver services, and these arrangements would favor telemedicine if it is the less costly alternative. If telemedicine were most costly and the health benefits worth the cost, monitoring might be needed to ensure the quality of care.
远程医疗的经济评估比较了通过远程医疗与其他替代方式提供特定服务的成本及其他后果。成本效益分析是用于健康问题的最常用方法，有助于评估预期的健康效益是否值得投资。远程医疗给评估者带来了特殊挑战：远程医疗系统可能有多种用途和共同成本，难以分摊到一项服务上；系统的存在可能导致使用指征扩大；技术变革可能迅速使评估过时。公共和私人监管及支付可能会影响远程医疗的推广。美国食品药品监督管理局的政策存在不确定性，其仍在制定立场。临床医生的执照和资质认证政策正在发生变化，传统上这些认证是由州和地点进行的，以反映远程医疗服务可能跨越这些区域界限这一事实。远程医疗服务缺乏保险覆盖被认为是按服务收费支付方式下采用该服务的障碍。然而，在按人头支付和固定预算的情况下，提供者有经济动机采用最有效的方法提供服务，如果远程医疗是成本较低的选择，这些安排将有利于远程医疗。如果远程医疗成本最高而健康效益值得付出成本，则可能需要进行监测以确保医疗质量。
