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9 Health L. Rev. 3 (2000-2001)

handle is hein.journals/hthlr9 and id is 1 raw text is: Introduction Telehealth,' broadly defined, is the use of telecommunications and information tec hnolo gies to overcome geographic distances between health care practitioners or between practitioners and patients for the purpose of diagnosis, treatment, consultation, education and health information transfer. The vastness of Canada has made the delivery of health services to its widely dispersed population difficult at the best of times. The adoption of innovative approaches or technologies is often a necessity. The growing interest in telehealth in Canada is a case in point. Canada was one of the first countries in the world to adopt telehealth. Telehealth is increasingly seen as an important tool for enhancing health care delivery, particularly in rural and remote areas where health care resources and expertise are often scarce or even non-existent. Services and expertise from major centres and health care facilities can be brought to such communities with the help of telecommunications and information technologies. Over the last few years, there has been a rapid increase in telehealth activities. A recent nation-wide survey conducted by Industry Canada has identified scores of telehealth projects.2 The founding of the Canadian Telehealth Society and the Telehealth Association of Ontario in 1998 reflects the widespread interest in telehealth-related activities in this country. Until recently, most telehealth pilot projects and studies have focused on overcoming technological challenges and demonstrating clinical efficacy, but more and more people are beginning to ask questions about the policy and economic aspects of telehealth. They are interested in finding out how telehealth can be integrated into the health care system, how certain policies may facilitate orhinderthe application of telehealth and how cost effective telehealth is. One of the major concerns is reimbursement, especially in relation to whether and how practitioners are compensated for their involvement in telehealth. Potential problems relating to reimbursement have received considerable attention and discussion, but progress has been slow in many jurisdictions. Although telehealth can be used for many purposes, such as in home care, triage, emergency alert, health information hot line, continuing medical education and patient education, the present paper focuses on the diagnosis and treatment of diseases and physician consultations.3 Also, while many categories of health care practitioners are involved in telehealth activities, much of the discussion in this paper centres on physicians because the debate on reimbursement focuses on medical practitioners at this stage of telehealth development. However, many of the issues and policy options discussed are equally pertinent to other practitioners. Telehealth technologies and activities are changingby leaps and bounds. The discussion that follows mostly reflects the situation in early 1999 when the research was initially conducted, though efforts were made to incorporate more recent developments in the paper. This paper is divided into several major sections. Following the introduction, the research methodology is outlined inthe second section. This is followed by a discussion of the policy issues and their significance. The major findings and analysis are presented in two sections. The first discusses the current status of physician reimbursement as it relates to telehealth. It also describes how Canada and selected foreign countries deal with this problem. This is followed by a discussion of a number of policy options for addressing the reimbursement issue. Each option is examined in terms of its pros and cons. The second last section identifies several related issues. The paper ends with a discussion of telehealth reimbursement issues from a broader policy perspective. Volume 9, Number 1 Reimbursing Physicians for Telehealth Practice: Issues and Policy Options Raymond W. Pong & John C. Hogenbirk 3

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