Determining if Telehealth Can Reduce Health System Costs: Scoping Review.
Determining if Telehealth Can Reduce Health System Costs: Scoping Review.
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DOI：
10.2196/17298
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发表时间：
2020-10-19
影响因子：
7.4
通讯作者：
Caffery LJ
中科院分区：
文献类型：
--
作者：
Snoswell CL;Taylor ML;Comans TA;Smith AC;Gray LC;Caffery LJ
远程医疗对澳大利亚来说是一个机会，可以利用技术的力量来重新设计医疗保健的提供方式。远程保健的潜在好处包括更容易获得护理，通过减少旅行提高卫生服务提供者和患者的生产率，节省成本的潜力，以及开发对特殊人群的需求更加敏感的符合文化的服务的机会。远程保健的普及有时受到临床医生不情愿和阻止大都市居民获得远程保健服务的政策的阻碍。这项研究旨在调查与传统服务模式相比，远程医疗是否降低了医疗系统的成本，并确定了可以实现成本节约的情景。为达到研究目标，进行了范围界定审查。最初，使用远程医疗和经济学的广义术语进行文献搜索，以确定远程医疗的经济评估文献。研究人员随后进行了一个专家焦点小组，以确定远程医疗可以降低医疗系统成本的领域，然后有针对性地对文献进行搜索，以寻找相应的证据。所审查的费用分析提供的证据表明，当防止了由卫生系统资助的旅行时，以及当远程保健通过以更有效的方式提供称职的护理而减少了对昂贵的程序性或专科后续行动的需要时，远程保健降低了费用。专家小组确定了远程医疗可能节省的4个领域：生产率提高、二级护理减少、替代筹资模式和远程监护。远程医疗显示了通过重新设计医疗系统来提高生产率的巨大潜力；然而，在澳大利亚基于活动的资助下，这些收益不太可能带来成本节约。减少二次保健使用是远程保健的一个有希望的领域；然而，许多研究并没有证明由于管理和监测远程保健系统的成本而总体上节省了成本。在消费者自掏腰包接受服务的情况下，远程医疗系统的替代筹资模式有可能节省医疗系统的资金。远程医疗的经济评估微乎其微；然而，从长远来看，它可能会通过提高多面手和专职医疗临床医生的技能而无意中节省成本。考虑实施远程保健的卫生服务应该受到利益的推动，而不是降低成本。现有证据表明，尽管远程保健提供了压倒性的积极患者利益，并提高了许多服务的生产率，但目前的证据表明，它并不能照例降低保健系统的护理费用。
Telehealth represents an opportunity for Australia to harness the power of technology to redesign the way health care is delivered. The potential benefits of telehealth include increased accessibility to care, productivity gains for health providers and patients through reduced travel, potential for cost savings, and an opportunity to develop culturally appropriate services that are more sensitive to the needs of special populations. The uptake of telehealth has been hindered at times by clinician reluctance and policies that preclude metropolitan populations from accessing telehealth services. This study aims to investigate if telehealth reduces health system costs compared with traditional service models and to identify the scenarios in which cost savings can be realized. A scoping review was undertaken to meet the study aims. Initially, literature searches were conducted using broad terms for telehealth and economics to identify economic evaluation literature in telehealth. The investigators then conducted an expert focus group to identify domains where telehealth could reduce health system costs, followed by targeted literature searches for corresponding evidence. The cost analyses reviewed provided evidence that telehealth reduced costs when health system–funded travel was prevented and when telehealth mitigated the need for expensive procedural or specialist follow-up by providing competent care in a more efficient way. The expert focus group identified 4 areas of potential savings from telehealth: productivity gains, reductions in secondary care, alternate funding models, and telementoring. Telehealth demonstrated great potential for productivity gains arising from health system redesign; however, under the Australian activity-based funding, it is unlikely that these gains will result in cost savings. Secondary care use mitigation is an area of promise for telehealth; however, many studies have not demonstrated overall cost savings due to the cost of administering and monitoring telehealth systems. Alternate funding models from telehealth systems have the potential to save the health system money in situations where the consumers pay out of pocket to receive services. Telementoring has had minimal economic evaluation; however, in the long term it is likely to result in inadvertent cost savings through the upskilling of generalist and allied health clinicians. Health services considering implementing telehealth should be motivated by benefits other than cost reduction. The available evidence has indicated that although telehealth provides overwhelmingly positive patient benefits and increases productivity for many services, current evidence suggests that it does not routinely reduce the cost of care delivery for the health system.
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DOI：
10.1002/hed.24916
发表时间：
2017-12-01
影响因子：
2.9
作者：
Burns, Clare L.;Kularatna, Sanjeewa;Kenny, Lizbeth M.
通讯作者：
Kenny, Lizbeth M.
影响因子：
7.4
作者：
Chen YH;Lin YH;Hung CS;Huang CC;Yeih DF;Chuang PY;Ho YL;Chen MF
通讯作者：
Chen MF
影响因子：
7
作者：
Choi, Sung J.;Nyman, John A.;Kroenke, Kurt
通讯作者：
Kroenke, Kurt
影响因子：
4.7
作者：
Bergmo, TS
通讯作者：
Bergmo, TS
DOI：
10.1089/tmj.2006.0035
发表时间：
2007-04-01
期刊：
TELEMEDICINE JOURNAL AND E-HEALTH
影响因子：
--
作者：
Armstrong, April W.;Dorer, David J.;Kvedar, Joseph C.
通讯作者：
Kvedar, Joseph C.