遠程醫療自付額及生產力成本對於蒙古鄉村人口有皮膚病人的衝擊

Impact of mobile telemedicine on out of pocket expenditures and lost productivity cost of patients with skin disease in Mongolian rural population

Enkhtuvshin Davaasuren(Enkhtuvshin Davaasuren)

指導教授 ： 簡文山

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2015年)

https://doi.org/10.6831/TMU.2015.00009

摘要

Background: Access to medical care in rural areas is a challenge in every country around the world. Moreover, improving access to medical care is important issues in all level of health care system worldwide. Currently, information and telecommunications technology has been investigated for more than 40 years in an effort to achieve those goals (Guler et al., 2002). Telemedicine is becoming more prominent part of dermatology and it offers the opportunity for significant cost savings. From patients’ perspective, these include travel expenses and lost work time for appointments. Nowadays, mobile telemedicine is increasingly growing in developing countries. Because of low population density and huge land, delivering medical care to rural population is current problem in Mongolia. To solve this problem, health care organizations implemented several projects in different levels. Project “Teledermatology Solution through Mobile Phone in Rural Mongolia” was done for a period of 5 months in 2013-2014 at 20 rural health clinics in Mongolia by Taipei Medical University, Mongolia National University of Health Sciences and National Dermatology Center in Ulaanbaatar.
Objectives of the study: Objective of present study were to estimate out-of-pocket expenditure and productivity losses of patients with skin diseases in rural areas of Mongolia, as well as, to determine how mobile telemedicine affects out-of-pocket cost and lost productivity cost of patients with skin diseases.
Methods: We used the cost questionnaire for completion by patient to estimate patients’ OOP and Lost productivity of both telemedicine and conventional care. We conducted retrospective study using face to face interview method in mobile telemedicine implemented two soums of Bulgan province, Mongolia. All data of OOP costs and LP costs were collected by using Mongolian tugriks (MNT) and data were converted and presented by using US dollars (USD). Data were analyzed by one way ANOVA, post hoc and T test (p <0.05).
Results: In telemedicine care, average OOP cost of the patients with single medical visit to GP was 17.8 USD and medical visit with inpatient/outpatient treatment was 18.3 USD. In conventional health care, average OOP cost of the patients with single medical visit to dermatologist was 76.4 USD and medical visit with treatment was 133.5 USD. Average patient’ LP costs were 12.3 USD with telemedicine and 34.7 USD without telemedicine. The results of our study telemedicine significantly decreases total OOP costs as well as travel costs, consultation and diagnostic fee, food expense, for both patients with single visit and visit with treatments. Patients saved 85.3% (16.8 USD) on travel costs, 39.0-73.9% (10.3-44.4 USD) on prescribed medications and treatment costs, 75.5-86.1% (57.3-114.8 USD) on total OOP costs and 52.7-89.5% (13.7-17.8 USD) on LP costs. Totally patients with single medical visit saved 78.9% (73.1 USD) and patients with treatments saved 81.8% (137.6 USD) on household expenditures with telemedicine.
Conclusion: Our study suggested that mobile telemedicine positively influence economy of patient’s family and showed that mobile telemedicine saved rural patients’ household expenditure in Mongolia.

關鍵字

Patients cost savings ； OOP cost ； lost productivity ； mobile telemedicine ； teledermatology

並列摘要

Background: Access to medical care in rural areas is a challenge in every country around the world. Moreover, improving access to medical care is important issues in all level of health care system worldwide. Currently, information and telecommunications technology has been investigated for more than 40 years in an effort to achieve those goals (Guler et al., 2002). Telemedicine is becoming more prominent part of dermatology and it offers the opportunity for significant cost savings. From patients’ perspective, these include travel expenses and lost work time for appointments. Nowadays, mobile telemedicine is increasingly growing in developing countries. Because of low population density and huge land, delivering medical care to rural population is current problem in Mongolia. To solve this problem, health care organizations implemented several projects in different levels. Project “Teledermatology Solution through Mobile Phone in Rural Mongolia” was done for a period of 5 months in 2013-2014 at 20 rural health clinics in Mongolia by Taipei Medical University, Mongolia National University of Health Sciences and National Dermatology Center in Ulaanbaatar.
Objectives of the study: Objective of present study were to estimate out-of-pocket expenditure and productivity losses of patients with skin diseases in rural areas of Mongolia, as well as, to determine how mobile telemedicine affects out-of-pocket cost and lost productivity cost of patients with skin diseases.
Methods: We used the cost questionnaire for completion by patient to estimate patients’ OOP and Lost productivity of both telemedicine and conventional care. We conducted retrospective study using face to face interview method in mobile telemedicine implemented two soums of Bulgan province, Mongolia. All data of OOP costs and LP costs were collected by using Mongolian tugriks (MNT) and data were converted and presented by using US dollars (USD). Data were analyzed by one way ANOVA, post hoc and T test (p <0.05).
Results: In telemedicine care, average OOP cost of the patients with single medical visit to GP was 17.8 USD and medical visit with inpatient/outpatient treatment was 18.3 USD. In conventional health care, average OOP cost of the patients with single medical visit to dermatologist was 76.4 USD and medical visit with treatment was 133.5 USD. Average patient’ LP costs were 12.3 USD with telemedicine and 34.7 USD without telemedicine. The results of our study telemedicine significantly decreases total OOP costs as well as travel costs, consultation and diagnostic fee, food expense, for both patients with single visit and visit with treatments. Patients saved 85.3% (16.8 USD) on travel costs, 39.0-73.9% (10.3-44.4 USD) on prescribed medications and treatment costs, 75.5-86.1% (57.3-114.8 USD) on total OOP costs and 52.7-89.5% (13.7-17.8 USD) on LP costs. Totally patients with single medical visit saved 78.9% (73.1 USD) and patients with treatments saved 81.8% (137.6 USD) on household expenditures with telemedicine.
Conclusion: Our study suggested that mobile telemedicine positively influence economy of patient’s family and showed that mobile telemedicine saved rural patients’ household expenditure in Mongolia.

並列關鍵字

Patients cost savings ； OOP cost ； lost productivity ； mobile telemedicine ； teledermatology

參考文獻

ATA (2010a). Survey on Teledermatology Activity in the U.S. (2003): American Telemedicine Association.

Akematsu Y, Tsuji M (2009). An empirical analysis of the reduction in medical expenditure by e-health users. Journal of telemedicine and telecare 15(3): 109-111.

ATA (2010b). Telemedicine Defined: American Telemedicine Association.

Baze MR Application and Evaluation of Teledermatology In An Underserved Area of Honduras. Doctor of Philosophy, The Virginia Polytechnic Institute and State University, Blacksburg, Virginia, 2011.

Bendixen RM, Levy CE, Olive ES, Kobb RF, Mann WC (2009). Cost effectiveness of a telerehabilitation program to support chronically ill and disabled elders in their homes. Telemedicine journal and e-health : the official journal of the American Telemedicine Association 15(1): 31-38.