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In the year 2018, the current people of this planet are living in a digital age. With technology advancing faster than ever the question becomes: Should the current state of healthcare be as transformative as the technology we have today and by doing so, is there a cost benefit? Virtual appointments in the medical profession are not as uncommon as some would like to think. There appears to be a greater need for patients to receive medical care from the comfort of their own home for a variety of factors but the driving factor in today’s society is money. The research question for this paper specifically focuses on: Are virtual doctor appointments an economic benefit to the patients? If so, how much money can a patient save on average compared to a face-to-face appointment. With an array of academic literature published in journals like The Telemedicine and E-Health Journal, this paper will specifically look into the cost benefits of virtual doctor visits. With numerous studies published, I will focus my research on the cost benefit for chronically ill patients as well as patients who live far outside a primary care provider. By doing so, I am going to show the breadth of the cost savings from a variety of perspectives to see the economic gain of virtual visits is something every patient should have access to or if the cost benefit only works for a select group of individuals.
In order to understand the potential cost savings benefits of virtual healthcare it is equally important to understand the cost of going to the doctor in a variety of settings and with or without medical insurance. According to America’s Debt Help Organization, a nonprofit organization, provides information for an array of differing medical appointments. On their website they claim the average amount it costs a patient to see a doctor for 15 minutes for a level three appointment (i.e., someone with the flu) the average cost without insurance was $104. When bundled with the average health insurance the price drops to $69, a difference but not a significant difference (America’s Debt Help Organization, 2018). Other areas focused are the price of a tetanus shot without insurance is $28, 40 minutes with the doctor for a more serious matter is roughly $204 and seeing the doctor for 10 minutes to get an ear cleaned out or to do a strep test is $68 (without insurance).
The question after reviewing the data becomes, is there a cost-effective alternative to general in person doctor visits. Focusing on virtual appointments opens the door for conversations about the current healthcare system as well as reviewing already published literature to see the cost benefits. Virtual medical appointments are more common than what meets the eye, the question now is really diving into cost to see if practices across the United States should be giving patients the option. Factors addressed in this paper include but are not limited to, the overall cost of the appointment (typically with insurance), travel cost (mileage), and the overall comfort for the patient which may not be monetary cost but personal mental health costs.
This paper is going to focus on two studies in order to answer the question of the cost-effectiveness of virtual healthcare benefits. I am not able to perform my own study at this time, so I am going to review literature which looks specifically at the overall costs for virtual health appointments. By looking at literature I am able to get a broader perspective on the topic. If I were doing my own research I would be limited to the area of the state in which I live and the demographics of my location. By reviewing literature, I am gaining a multitude of perspectives from chronically ill patients to rural patients who have a harder time accessing healthcare based on their location. The major disadvantage of not performing my own research falls into reading and interpreting someone else’s work. However, through methods such as the CRAAP test, I am able to ensure credibility, a major component in holding a piece of literature to a high enough standard to be presented in this paper. Of three pieces of literature I have selected for this study two come from various publications in The Telemedicine and E-Health Journal by various researchers who hold extreme credibility and authorship within their fields and one piece published by the BMC Health Service group.
The first study published by Finkelstein et al., in The Telemedicine and E-Health Journal, look at the cost-effective benefits for patients who are considered to be chronically ill. In this study, a team of researchers dive into the question of a cost benefit for patients who are chronically ill. In their study the team of researchers selected a randomized group of thirty chronically ill patients and randomized them yet again to receive the same treatment as they would from a face-to-face. The patients were divided into three groups: one receiving virtual healthcare (C), one receiving at home nurse care (V), and the third group went into the doctor to receive their care there (M). They also looked at the discharge rate which helps determine the cost because longer treatment results in a higher bill. By comparing the three subgroups, the team of researchers were able to determine the average cost for someone receiving face-to-face care to those who were receiving virtual care from their own homes.
The second study published by Zanaboni et al., specifically focused their research on individuals or families who lived far outside the accessible access to healthcare or in a rural community. By using this specific demographic, the team of researchers were looking at the cost benefits of virtual health care and comparing it to the overall costs as well as the overall miles traveled. In this study they looked at 957 teleconsultation contracts, or those responsible setting up the possibility of the virtual appointments. They focused on 812 patients with symptomatic issues or concerns in 30 rural communities. The researchers referenced 48 general practitioners throughout the course of the study as well. The overall aim of study was to see if virtual healthcare visits to patients living in a rural community were cost effective as well as overall effective for the health of the patient.
The third study posted in The Telemedicine and E-Health Journal, Noel et al., specifically looked at the overall feasibility, which in turns allows the cost benefits to be shown. In this study, the two researchers looked at how cost effective it was to implement the virtual healthcare practice from the perspective of not only money but the comfort of the doctor and patient having a virtual appointment. The study was done with a total of 104 patients with chronic illness: heart failure, lung disease, and diabetes were evaluated virtually first and then reevaluated in a face-to-face setting to see if the doctors would provide the same type of treatment and in turn looking at overall effectiveness from monetary and mental perspectives.
In the first piece, Finkelstein et al., found a correlation between virtual healthcare appointments and a lower cost to the chronically ill patients. In their study they found patients who were receiving virtual healthcare had a 42% discharge rate after 6 months of the study. When doing the math, that is 4.2 patients out of the ten who were put into this group received their healthcare and were able to be done with treatment within 6 months. When comparing the 42% of virtual healthcare patients to the next group, only 15% or 1.5 patients were discharged who received at home nursing care. That is more than half, which correlates to a lower cost of healthcare since more patients were being discharged after the same amount of time. Lastly, they found patients who went in for a face-to-face appointment 21% of those patients or 2.1 patients were being discharged after 6 months. When looking at the data the researchers stated the average cost of going for the face-to-face visit was $48.27, $32.06-$38.62 for at home nursing (depending on the care performed and insurance), and $22.11 for patients who were receiving virtual healthcare. The data shows nearly a 50% difference between face-to-face and virtual healthcare and over the 6 months those numbers could and do add up, creating higher costs to patients receiving the same level of care but in a variety of settings.
One interesting component to note about the first study is they did not reference the type of chronic illness the patients had. By not knowing their illness it was impossible to tell the severity. Patients with more aggressive or severe long-term illnesses are going likely need more time in order for treatment to work. By randomizing the group, it is almost impossible to tell if the group receiving virtual healthcare had patients with lesser severity illnesses compared to the other two groups.
The second study performed by Zanaboni et al., found a correlation between virtual healthcare saving people in rural area money when compared to those same people going to face-to-face appointments. They found of their 812 patients in the 30 rural communities that 86% of patients reported a lower cost to them. In 5% of the cases they found timeliness in the practice of virtual healthcare was faster and less time consuming, meaning the appointments took less time but the patients were more satisfied with their care. Lastly, 95% of patients, or 771 people, reported their experience as overall effective and would do it again because of the quality of care they received.
When looking at this more closely, the article did not publish the costs, just the notion patients reported a lower cost to healthcare. The authors do mention a driving factor to the increase in savings is the patients were saving money because they did not have to drive 30+ miles to the appointment. In 2008-2009, the average cost of gas was roughly $4.00 fluctuating slightly higher or lower depending on location and month. By 30 miles there and back for a 10-minute appointment, the cost of gas could add up significantly and quickly. Knowing this information and looking at the first study which was published only three years prior when gas prices were relatively close in price: in 2006 the price of gas averaged around $3.00 and in 2008 averaged around the $4.00 mark, so it plausible to conclude mileage added to overall cost and can assume with confidence patients were paying roughly 50 dollars for in person healthcare on top of the price of gas.
The third study looked specifically at three hears, the quality of life, health resources being used, and the overall cost. Noel et al., found by using virtual healthcare, there was a large decrease at the 6-month mark with day to day care, reducing the cost to the patient. They also found fewer patients who were receiving virtual care were visiting the emergency room less, as well as urgent care office visits. They also found an increase at 3 and 6 month checks with the overall satisfaction of patients, which increase mental health benefits to virtual care.
Studies two and three do not specifically mention numbers when they talk about decrease in costs. They use strong language like significantly and drastically making claims there is a large enough difference to support the idea of virtual healthcare. By having a wide variety between studies two and three with whom is being treated, it can be said there is a cost reduction for patients who have access to virtual healthcare. Studies two and three also look at the benefit to the patients’ overall quality of health which ranges from satisfaction surveys on their overall treatment to how they would rate their quality of life.
All three studies pose uniqueness because they look at a different subgroup for their studies. By representing a variety of clientele, it can be seen across the spectrum there is a cost benefit to the patients. Throughout all three studies there were numerical measures to indicate these costs benefits as well as sampling larger portions of people at once to show significant data. By having control groups of 30 or greater, the studies themselves gained reputability by having a larger sample size. Randomization was another key factor in the studies and by randomizing it provided authenticity in the study because it eliminated bias since no one could predetermine who was going to be in what group. Having more than one group receiving a different treatment time created a sense of validity because it gave the researchers something to compare their data and put it up against their hypotheses. In the ever changing, technology driven, global world the reality of virtual healthcare is becoming more and more present. The research presented demonstrates how virtual healthcare is cost effective for the patient. The relevancy is apparent throughout based on the digital world and patients living further away from accessible healthcare. This is important these studies were conducted because if the technological trends continue healthcare needs to be relevant with the times and meet the needs of their patients. Continuing on, with medicine itself ever changing the way medicine is practiced should be changed as well. This goes without saying there will always be times where going to the doctor is necessary but if a person can doctor in a secure and safe setting from the comfort of their own home, the patient should be able to with the current technology. However, patients need to be aware of virtual health communities which play an important factor in virtual healthcare. Having a community where patients can relate to, seek advice, and find comfort in their own health is a great benefit of virtual health. It comes without caution though. There needs to be a public awareness of fake medicine and websites targeting consumers to take their money or give them false diagnoses.
The research is prevalent because not only has it shown to be cost effective for the patients, there is another major component addressed by Noel et al., is patient salinification. It goes without saying the sample size cannot be a representation of the United States’ population, however, it can be said with a confidence interval of almost 90%, patients were satisfied with virtual healthcare out of the 812 patients in the tests. Patient satisfaction is equally important to cost benefits because if the patient is going to do virtual healthcare they need to feel valued and trust the doctor treating them just like they would in a face-to-face appointment. Both economic costs and the overall mental health benefits equally represent the trend of patients wanting to try virtual healthcare appointments.
The results hold value due to the variety of people represented in the data. With a wider variety of clientele, it shows the breadth of virtual healthcare in its many forms. Virtual healthcare can be for anyone, for a chronically ill patient to someone who would like a general checkup who lives 30 miles from the nearest doctor. To further the results, it is imperative for researchers to continue broadening their research by reaching more demographics. The studies presented in this paper were all concluded before the year 2010. Since then there have been major changes to the way people communicate virtually and showing the advancement of the technology doctors and patients should be aware.
Lastly in order to make virtual healthcare a current medical practice the public and doctors need to become more educated on how the process would look and feel. For many years doctors have done live surgeries or live consultation so being in front of the camera is not necessarily new. What is new is how doctors and patients will interact virtually. The professionalism and mannerisms will change, they may be subtle, however, doctors need to be aware of how to talk to patients virtually rather than face-to-face. On the patient end, it may be quicker and cheaper, however, it loses a sense of authenticity since it virtual Patients will need to learn to build trust in an online community and understand that virtual healthcare may be the future, but they need to be willing to adapt and trust online. Technology is here, and virtual reality and healthcare is ever advancing. Many people are beginning to experiment with virtual healthcare by emailing their doctors from smartphone apps, to calling in to see if they should even go to the doctor. Virtual healthcare is at the panicle stage where it can either be transformative or fall below the cracks and medicine will continue moving on and face-to-face will remain the norm.
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