Regulation of Telemedicine Costs Lives
Jason Shafrin writes:
In response to concerns about tele-medicine’s effect on patient safety, many states have begun prohibiting physicians from prescribing drugs without conducting a prior physical examination. In fact, more than 30 states have instituted this type of rule since 1998.
A paper by Cotet and Benjamin investigates this regulation which they call the physical examination requirement (PER).
The findings:
The adoption of PER is associated with a 1% rise in disease-related mortality rates the equivalent of 8.5 deaths per 100,000 people, presumably because it raised the implicit cost of, and thus reduced access to, medical care. In addition, the adoption of the PER is associated with a 6.7% reduction in injury-related mortalities, the equivalent of 2.5 deaths per 100,000 people. Thus, the reduction in injury mortality is smaller than the elevation of disease-related mortality, yielding a rise in overall mortality.
Regulations like these are so misguided. While I understand the reasoning behind PER regulations, results like these are show that the reasoning doesn’t match the results.
Health care should be driven by outcomes as revealed through data. Thank God for studies like these that shine a light on deadly red tape.
Comparative data like this is so helpful to have. Proponents of these regulations only look at one side of the data. An even-handed examination of both sides clearly reveals that this is a regulation that needs to end.
Some of the safety concerns about some drugs could be handled at the point of service, e.g., by a pharmacist, pharmacy assistant or paramedic taking a patient’s pulse and blood pressure. But the requirement to see the physician is obviously an economic protection measure: otherwise, the laws would specify what tests have to be performed. Without a blood test, e.g., it would be difficult for a physician to detect rare, fatal side-effects simply by eyeballing the patient.
Another example of how regulations do more harm than good.
I found the first article under “related posts” about alcohol taxes very intriguing. I like your related posts feature and think it’s great to be able to investigate interesting topics further: good stuff!
Good to have these comparisons.
Out here in the less populated west, you might be in a car crash in a remote area, have a bunch of scans, and be diagnosed by a specialist hundreds of miles away.
If the go-to specialist is in the same state, no problem. If he isn’t, well, let’s just say I listened to a specialist go on and on about the hassles of getting permissions to legally operate across state borders on a regular basis.
The PER may have initially been put in place to benefit physicians, but more recently they protect the public from rogue Internet pharmacies. Without PER, we would see a new “pill mill” source pop up on the Internet every minute. I would rather see states move toward accepting a telemedicine exam to be the equivalent of an in-person exam to establish a doctor-patient relationship. This would lay the legal groundwork for a physician to prescribe prescription medication. In this way, the patient would be known to the doctor and the patient would know the doctor’s expertise.
Already too many doctors are prescribing opiates and other drugs without adequate training.