The amendment to the Medical Service Act that institutionalizes telemedicine recently passed the National Assembly. Telemedicine, which had been operated temporarily during COVID-19, has been incorporated into the formal system and is set to be implemented in earnest. North America has already used phone- and video-based remote care as routine medicine for decades. We visited the North American field to look at how it actually operates. [Editor's note]
"With a public remote medical platform supported by the province, we can treat patients with depression."
On the 28th of last month (local time) at St. Thomas Elgin General Hospital in Ontario, Canada, psychiatrist Giuseppe Guaiana said this.
In the clinic was a notice that read, "Is transportation difficult? Try remote psychiatric care." Next to the notice were a computer, a camera and a phone.
He uses OTN (Ontario Telemedicine Network), a public remote medical platform provided by the provincial government, free of charge.
Doctors can apply to use OTN and receive an ID. Using a smartphone, laptop or tablet PC, they select the appointment date and time, the patient's name and the medical department, then meet the patient on screen. The doctor asks about symptoms, prescribes medication or sets up the next appointment. He said it helps patients living in medically underserved areas.
◇Public platform, free to use at hospitals… resolves language barriers
Remote care began in Canada in the late 1970s and became fully established with the advent of COVID-19. According to Canada Health Infoway, a nonprofit organization related to remote care, the share of telemedicine rose from 15% before COVID to 40% afterward.
Remote care helps solve the so-called "medical desert" problem, because it lets patients overcome travel distances to see a doctor.
Guaiana said, "Some parts of Canada are perceived as undesirable places to live because of long distances and cold weather, so some doctors do not prefer them," adding, "Patients living in remote areas can receive care from good urban hospitals via remote care." He added, "Without remote care, even attending to basic mental health would have been difficult." In other words, it can overcome some doctors' reluctance to work in certain regions.
Patients can eliminate language barriers through remote care. For example, in Manitoba, some patients speak French. Before remote care, patients often had difficulty finding hospitals that offered care in French and had to fly long distances. Now they receive care on smartphones with real-time interpretation available. A Canada Health Infoway official said, "Linguistic minorities can also access treatment."
Lee Jae-heon, a psychiatrist at Victoria Hospital (London Health Sciences Center) in London, Ontario, said, "With virtual consultation, we can ensure continuity of care for patients," adding, "It is useful for patients who had hip surgery and are recovering when driving is dangerous due to heavy snow, or for older adults with limited mobility."
◇Abroad, telemedicine and in-person costs are similar… Korea debates fee overhaul
In Korea, with the Medical Service Act amendment passed by the Cabinet, telemedicine will be fully implemented at the end of next year. Further discussion is needed on which platforms doctors will use for remote care. Some worry that for-profit private platforms could encourage overtreatment or dominate the medical market.
Experts advise looking to Ontario's public platform policy. In Ontario, when doctors provide telemedicine, they receive 85% of the in-person rate as an expense.
If doctors use the public OTN platform, they can receive an incentive equivalent to the remaining 15%, making the expense effectively 100% identical. They can use private platforms, but the system is designed so there is no reason to choose them over the public platform.
A Ministry of Health and Welfare official said, "In Korea, private platform companies that have filed a telemedicine brokerage notification can provide remote care," adding, "If the number of subscribers exceeds a certain size, they must also be certified by the Minister."
The official added, "A public platform (developed) through a commission to a public institution is also expected to be available for telemedicine," and "We expect to adopt a public platform while continuing to use existing private platforms."
For telemedicine, the fee schedule (money paid to hospitals by the National Health Insurance Service) also matters. In Korea, since the telemedicine pilot project, the rate has remained at 130%—30% higher than in-person care. However, the telemedicine fee schedule will be adjusted. A Ministry of Health and Welfare official said, "We will prepare a telemedicine fee overhaul after discussions with the Health Insurance Review & Assessment Service (HIRA) and others."
Abroad, there is little difference between telemedicine and in-person fees. According to Canada Health Infoway, in Ontario, British Columbia and Quebec, telemedicine and in-person care are the same. In Saskatchewan, telemedicine is about 90% of in-person care.
Rashaad Bhyat, senior clinical leader at Canada Health Infoway, said, "Telemedicine also provided an expense equal to in-person care and encouraged participation by medical staff."