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 part of everyday medicine for decades. We visited sites in North America to see how it actually operates. [Editor's note]
"We can treat patients with depression through a state-supported public telemedicine platform."
On the 28th of last month (local time) at St. Thomas Elgin General Hospital in St. Thomas, Ontario, Canada, psychiatrist Giuseppe Guaiana said this.
In the doctor's office, there was a notice that read, "Having trouble with transportation? Get psychiatric care remotely." Next to the notice were a computer, a camera and a phone.
He uses OTN (Ontario Telemedicine Network), a public telemedicine platform provided by the provincial government, for free.
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 clinical department, then meet the patient on screen. The doctor asks about symptoms, prescribes medication or schedules the next appointment. He said it "helps patients living in medically underserved areas."
◇Public platform, free to use at hospitals… solves language barriers
Telemedicine in Canada began in the late 1970s and took firm root with the emergence of COVID-19. According to Canada Health Infoway, a nonprofit related to telemedicine, the share of non-face-to-face visits increased from 15% before COVID-19 to 40% afterward.
Telemedicine helps solve the so-called "medical desert" problem because it allows patients to see doctors beyond travel distances.
Giuseppe Guaiana said, "Some parts of Canada are perceived as far and cold, not ideal places to live, so doctors may avoid them," adding, "Even patients living in remote areas can receive care remotely at good urban hospitals." He also said, "Without telemedicine, even basic mental health care would have been difficult." The implication is that it can overcome some doctors' aversion to certain regions.
Patients can remove language barriers through telemedicine. For example, in Manitoba, some patients speak French. Before telemedicine, it was hard for patients to find hospitals offering care in French, so some took flights and traveled long hours. 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 continuous care for patients," adding, "It is useful for patients recovering from hip surgery when heavy snow makes driving dangerous, or for older adults and others with limited mobility."
◇ Overseas costs for non-face-to-face and in-person care are similar… Korea weighs fee schedule overhaul
In Korea, with the Medical Service Act amendment passing the Cabinet meeting, telemedicine will go into full implementation at the end of next year. Further discussion is needed on which platforms doctors will use for remote care. Some worry that profit-driven private platforms could encourage overtreatment or dominate the health care market.
Experts advise looking to Ontario's public platform policy. In Ontario, when doctors provide non-face-to-face care, they receive 85% of the in-person expense.
If they use the public platform OTN, they can receive an incentive for the remaining 15%, making the expense effectively 100% the same. They can use private platforms, but there is little reason to choose them over the public platform.
A Health Ministry official said, "In Korea, private platform companies that have filed for telemedicine brokerage can provide remote care," adding, "If the number of subscribers exceeds a certain threshold, they must also obtain certification from the Minister (of Health and Welfare)."
The official added, "A public platform (developed) by outsourcing to a public institution is also expected to be able to support non-face-to-face care," and "It appears the public platform will be introduced while continuing to use existing private platforms."
The fee schedule (money the National Health Insurance Service pays hospitals) is also important for telemedicine. In Korea, the fee has remained at 130% from the pilot phase to now, meaning 30% more than in-person care. However, the telemedicine fee schedule is set to be adjusted. A Health Ministry official said, "We plan to prepare a telemedicine fee schedule overhaul through discussions with the Health Insurance Review & Assessment Service."
Overseas, there is little difference between non-face-to-face and in-person medical fees. According to Canada Health Infoway, in Ontario, British Columbia and Quebec, non-face-to-face and in-person fees are the same. In Saskatchewan, non-face-to-face is about 90% of in-person care.
Rashaad Bhyat, senior clinical leader at Canada Health Infoway, said, "Non-face-to-face care offers a level of expense equivalent to in-person care and has encouraged provider participation."