Volume 198 - Issue 11
Telehealth and equitable access to health care
Author: Victoria A Wade
Med J Aust 2013; 198 (11): 594-595. || doi: 10.5694/mja13.10039
Published online: 17 June 2013
Published online: 17 June 2013
Removing the Medicare rebates for telehealth in outer metropolitan areas is a short-sighted policy.
To the Editor: I write in protest about the short-sighted decision of the Australian Government to remove outer metropolitan areas from eligibility for Medicare rebates for telehealth from 1 January 2013. Since then, there has been a 29% drop in the number of video consultations, with 9476 recorded from 1 January to 28 February 2013, compared with 13 311 from 1 November to 31 December 2012.1
Telehealth is usually proposed as a tool suitable for the rural and remote locations of Australia, providing lower costs, increased access to specialists, improved collaboration, increased quality of local service and greater access to professional development.2 Yet barriers to care are more than geographical; they can be temporal, financial and cultural.3 In particular, the health care system remains inequitable while patients with disabilities face a range of barriers in achieving access.4 Telehealth assists in overcoming these barriers, enabling improved access to care in urban areas.5
We instituted a telehealth service in psychiatry and pain management to a general practice super clinic located in the City of Playford council area in Adelaide’s outer northern suburbs. This area is underserved, with a low socioeconomic status and poorer health outcomes.6 The South Australian branch of the Royal Australian and New Zealand College of Psychiatrists, and the Australian Pain Society, informed us that there were no private locally resident or visiting specialists in this area, and the referring general practitioners said that the particular patients seen would not otherwise have accessed specialist care. They included patients who were homeless, patients with disabilities or those who lacked their own transport.
I understand that the boundary changes were intended not to undermine existing outer metropolitan private specialists but, in this case, we were clearly able to bring private specialist resources into the area with benefit to patients. Additionally, we recruited health care students on clinical attachments to assist patients with their teleconsultations. At the same time, the students were able to learn from the specialists during the video communication sessions.
I propose two recommendations that would result in telehealth increasing equitable access to care: first, that underserved outer metropolitan areas of low socioeconomic status be reinstated for Medicare rebates for telehealth, and second, that patients with a disability should be eligible for video consultations regardless of their place of residence.
Competing interests
I am presently employed by the University of Adelaide and am managing a project on telehealth that is funded by the Department of Health and Ageing. Until July 2012, I was the unpaid Medical Director of Design Networks Pty Ltd, a small South Australian company that supplies telehealth services. I have been reimbursed by Design Networks and by Telstra for expenses incurred in the course of attending telehealth conferences in Australia.
References
- Department of Human Services. Medicare Australia statistics: Medicare item reports. https://www.medicareaustralia.gov.au/statistics/mbs_item.shtml (accessed Mar 2013).
- Moffatt JJ, Eley DS. The reported benefits of telehealth for rural Australians. Aust Health Rev 2010; 34: 276-281. i1142869
- Fortney JC, Burgess JF Jr, Bosworth HB, et al. A re-conceptualization of access for 21st century healthcare. J Gen Intern Med 2011; 26 Suppl 2: 639-647. CBBCGGFG
- MacLauchlan M, Mannan H, McAuliffe E. Access to health care of persons with disabilities as an indicator of equity in health systems. Open Med 2011; 5: e10-e12. CBBHGGEB
- Spaulding R, Cain S, Sonnenschein K. Urban telepsychiatry: uncommon service for a common need. Child Adolesc Psychiatr Clin N Am 2011; 20: 29-39.
- Australian Institute of Health and Welfare. Australia’s health 2010. Canberra: AIHW, 2010. (AIHW Cat. No. AUS 122; Australia’s Health Series No. 12.) http://www.aihw.gov.au/publication- detail/?id=6442468376 (accessed Dec 2012).