Are we Bringing Health Care Home or Sending it Overseas?

Get ready for outsourced health care. Last week I wrote TeleHealth: The Doctor Will See You Now, Remotely, but what if Remotely means someplace in India or China?

As Dr. David Lee Scher notes, interest in mHealth is driven by several factors, including:

1. The rising costs of health care;
2. The worsening shortage of primary care physicians, and an even greater shortage of specialists;
3. The shift away from diagnosis-related fee for service management of diseases to reimbursement based on wellness & measured outcomes; and
4. The advent of more widespread use of electronic health records (EHRs).

Also facilitating the move to mHealth is the widening popularity of smart mobile devices and availability of high-speed Internet access, including coverage of once under-served  rural & low-income markets.

Nerd Alert: I’ve long been a consumer advocate for BIG Broadband (fiber-to-the-home), fast wireless (Wi-Fi, WiMAX, LTE and 4G cellular), and bridging the Digital Divide. So I was excited by an exhibit I saw yesterday at ITExpo Austin. Telcordia was describing plans to use Wi-Fi protocols over new frequencies the FCC is opening for public use, called White Spaces. These are the collection of “guard band” spaces between broadcast TV channels, and companies are figuring out how to use them for data. The significance is that TV transmissions cover far longer distances than cellular and Wi-Fi. They also more easily penetrate walls in homes. So with white spaces, Internet access can extend into rural markets at lower cost. Telehealth advocates find that especially exciting since a primary beneficiary is people who  live far from  major hospitals but who can get care electronically – IF they have access to broadband Internet.

I also talked with several video conferencing companies about was that doctors in hospitals or private practice can use high-definition video calls to connect with patients, family advocates, and in-home caregivers – all at once on the same call. I’ve written about the need for compatibility among different video systems, and the two prominent solutions I’ve found so  far are Vidyo and Mirial, a company recently acquired by Lifesize Communications.

All of these developments in broadband Internet and mHealth / eHealth / telehealth / telemedicine will help drive down the cost of health care and increase quality, but they may introduce  unintended consequences.

Internet connections to Asia are often far faster than to Alabama, so that makes it easy to outsource knowledge-based jobs to countries with lower wages. We’ve already seen examples of Medical Tourism – “Sun, Sand & Surgery” vacations for major operations at lower cost – but how will society react when that concept extends to everyone and your telehealth provider employs practitioners in Bangladesh? Would we seen changes in how those services are regulated? What’s so different if the doctor is 10 miles away or 10,000? Will you care?