A Spoonful of Skype Helps the Medicine Go Down: The Potential and Pitfalls of Telehealth in the United States
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Telehealth could fundamentally change health care in the United States by delivering treatments via telecommunications across space and time. This thesis is built around three key questions for telehealth: Is telehealth an effective way to deliver care, especially in rural America? Why has the spread of telehealth been restrained? What proposals are being considered at the federal level to further the use of telehealth? First, I examine if telehealth is clinically effective and could successfully expand access to care in rural America. The existing medical literature is reviewed to find telehealth to be effective and shows that telehealth could alleviate the shortage of doctors in rural America. This chapter’s original contribution is quantifying the supply and demand of doctors for all 50 states and showing that telehealth can close the gap between demand and supply in most states with a physician shortage. Second, the public policies that have limited the spread of telehealth are examined both at the state and federal level The paper makes an original argument that three key policy barriers to telehealth are licensure, scope-of-practice rules and reimbursement and that these barriers fundamentally are a result of U.S. federalism. A case study of Oregon shows how states act as “laboratories of democracy” in the absence of coordinated national policy and are furthering access to care. Third, I analyze the telehealth legislative proposals that are currently pending before Congress to determine if they would help increase access to health care, if they would overcome the current policy barriers to telehealth and if they are politically viable. I review the existing literature showing why health care bills are difficult to pass. These insights are applied to the telehealth proposals to assess their political feasibility. Finally, I recommend public policy that would tie together the insights of the paper’s findings. This proposed telehealth framework would overcome the geographic barriers to providing care and reduce the policy barriers that result from federalism while remaining politically viable.