Need for Inclusion of Telemedicine in Private Health Insurance in Nepal
LITERATURE REVIEW
Quality health care delivery system in a community is a vital factor for economic development. In the case of people from rural areas, when one has a condition that cannot be treated by a local primary care doctor and is referred to a specialist 3 to 4 hours away then those who can’t afford to take day off of work tend to put it off or don’t go to the specialist until their condition gets even worse which at time ends up being much more expensive to treat. People also tend to not make the follow-up visit again because of the transportation and financial issues. This is when telemedicine becomes an efficient alternative. It equalizes the quality of health care internationally so that everybody, regardless of where they live, can have a similar quality of healthcare (Klonoff, Joseph, Poropatich, et al, 2009).
Starting with reimbursable telemedicine services will help assure that administrative leadership, at the highest levels, is committed to the strategic and financial support of telemedicine implementation. Unlike just a few years ago, most healthcare executives are investing in telemedicine programs (Waller and Stotler, 2018 ).
Nationwide healthcare insurance plans and private insurers are reimbursing telemedicine as a part of health insurance programs, but their credibility against the physical consultation is still being reviewed. The fundamental question is how services delivered through telemedicine compare with those delivered through alternative means (Sisk and Sanders, 1998). The cost of telemedicine and lack of reimbursement for it are among the major barriers in the development of telemedicine (Kruse, Karem, Shifflet, et al 2016). Another impactful barrier to the implementation of telehealth solutions has been whether the amount allowed for payment is enough to create an economic incentive for doctors (especially given the current demands on doctors and their staff’s time), and for system integrators and device manufacturers to develop the technology (Hoffman, 2020).
National Insurance Program of the United States
Medicare is the federal health insurance program for people in the U.S. who are 65 or older, while Medicaid provides the same services for low-income families. Telehealth services of Medicare as a substitute for in-person visits include consultations, office visits, psychiatry services, and some physician fee schedule services. Since telehealth coverage can differ from one state to the other, many restrictions apply to this type of coverage. The implementation varies in terms of what service providers will be reimbursed for delivering, as well as how the parity between in-person and telehealth consultations is expected.
However, opponents of telehealth argue that telehealth services are not equivalent to in-person services and therefore should not receive parity to in-person services in reimbursements. According to them, telehealth should not be reimbursed the same amount as in-person care because of the costs and the savings associated with the two. Telehealth services are cost-effective and efficient, but opponents have argued that reimbursement for services should “mirror” those savings. Because of higher risks, possible lack of quality in care, and cost savings, many physicians believe that telemedicine should not be reimbursed on the same level as in-person care (Yang, 2016 ). Just as many innovative or beneficial ancillary services delivered in person are not reimbursed, those and more may not meet requirements for claims submission when delivered over distance (Waller and Stotler, 2018 ).
In the case of licensing requirements, the full professional medical license usually covers the ability to perform telemedicine visits with patients residing in a particular state (Shah, Amann, and Karlitz, 2020).
Telemedicine infrastructure costs are still largely either borne by the provider or paid for through grant funding. This threatens the long-term viability of telemedicine projects. Reimbursement of telemedicine transactions by private insurance is still somewhat rare and government reimbursement through Medicare and Medicaid is generally limited to services provided to under-served populations in real-time (Silverman 2003).
In early 2020, the COVID-19 pandemic threw a wrench into healthcare delivery models across the USA. Recognizing that without widespread availability of safe and accessible healthcare, the COVID-19 pandemic might also bring with it the second wave of morbidity and mortality from untreated acute and chronic conditions, CMS, commercial carriers, and state governments acted with unprecedented speed to dramatically expand telemedicine access and reimbursement (Bajowala, Milosch and Bansal, 2020). The Centers for Medicare and Medicaid Services and several state governors and medical boards reduced the burden on multistate licensing requirements for out-of-state providers and increased reimbursement and recognition for telemedicine services across insurance carriers (Shah, Amann, and Karlitz, 2020). Before COVID-19, insurance coverage for telemedicine was far from complete and included several restrictions even for the older population under Medicare (Dorsey and Topol, 2020). When the COVID-induced emergency expansion of telehealth expires, coverage and reimbursement rules will likely revert at least partially to these policies. Reimbursing for telemedicine visits at the same rate as in-person visits has been instrumental in encouraging increased telemedicine adoption among providers (Bajowala, Milosch, and Bansal, 2020). Regulations involve specifics on what types of providers, types of care, location of patient and provider (type of facility and geographical area), and nuances regarding facility billing. Some current procedural terminology (CPT) codes allow for telemedicine, but many do not (Waller and Stotler, 2018 ).
Telemedicine reimbursement policies have been slow to adapt to rapid advances in technology and increased demand for the service. Stringent geographic coverage and payment restrictions from both public and private health insurers have been barriers to telehealth adoption among healthcare providers (Bajowala, Milosch, and Bansal, 2020).
The Case for China
The characteristics of effective healthcare systems for developing nations like China are:
(1) equitable access to quality care;
(2) affordable health insurance; and
(3) financial sustainability.
Access to healthcare in China is very inequitable. For example, although 60% of China’s population lives in rural regions, only 20% of China’s health services resources are located in rural regions. Telemedicine, which improves access to care, would help to rectify this maldistribution of resources. Given that a telemedical business can be established with existing technology and minimal capital expenditures, China could likely improve its healthcare system by providing insurance coverage for telemedical services. Such insurance coverage would stimulate providers to enter the telemedical market, thereby improving access to care in rural China.
Telemedicine is likely to mean that far fewer healthcare institutions will be needed, and conceptually a handful of cities might be able to provide specialized healthcare services to the world. Moreover, because of the worldwide expansion of both health insurance and capital markets, the increased ability of patients to pay for medical services indicates that today’s telemedicine market should continue to expand in parallel with the global expansion of the insurance market (McLean, 2006).
The Case for Developing Countries
In developing countries, if a patient is taken care of using a telemedicine system, the delivered healthcare may not follow traditional techniques and as a result, the telemedicine consultation cannot be covered by insurance. European Health Telematics Association’s (EHTEL ) research shows that in most countries where healthcare is not state-funded there is no reimbursement process for telemedicine (Mahoney, 2003).
There is a paucity of dedicated, focused, and visionary telemedicine leaders in developing countries. Whatever telemedicine work we see in these developing countries is due to the individual efforts of these leaders and brand ambassadors of telemedicine. Lack of formal organizational structure to deliver telemedicine services is the biggest barrier for the development of telemedicine services in any country. Being a hybrid discipline, it needs collaboration with all possible stakeholders at each level of the healthcare delivery system.
Most telemedicine applications require a high speed and reliable Internet bandwidth to run smoothly. Tele-surgery, real-time teleophthalmology, real-time teleradiology, and emergency consultation are some examples of such applications. Unreliable and low wideband internet pose barriers to smooth delivery of telemedicine service (Bali, 2018).
It is a common fact that many provider physicians and clients cannot fix the technical problems arising from computer systems and ICT networks. So, for the proper and smooth functioning of the telemedicine system, we need to train manpower to establish stable and continuous communication during teleconsultation. Unfortunately, there is a serious lack of such trained persons in the system in most of the developing countries. The time gap between acquiring hardware and the development of customized software is so large that by the time software is ready, the hardware becomes obsolete. This mismatch between software and hardware also creates a bottleneck in the development of effective telemedicine solutions. Most telemedicine applications require a high speed and reliable Internet bandwidth to run smoothly.
Standardization of both hardware and software, as well as guidelines for practice, would help program managers to overcome interoperability, portability, and security issues. Several developing countries do not have a systemic telemedicine industry which means that their services are equivalent to that of an in-person consultation. Telehealth should be considered part of our tool kit for delivering healthcare and not a replacement for existing care, by transcending the conventional boundaries of traditional health services. Appropriate clinician reimbursement is key to telehealth uptake (Bursell, Zang, Keech, et al 2016).
On Technology
Availability of appropriate internet services and technological competence plays a key role on the patient side. Privacy concerns matter, even if we are temporarily allowed to use less secure lines (Shah, Amann, and Karlitz, 2020). Most doctors are not aware of the latest information technology and find difficulty using modern IT gadgets. There is a lack of telemedicine experts in the healthcare sector. There is a need to include a few chapters related to telemedicine in the medical education curriculum to sensitize and orient budding doctors to learn the technical part of this discipline. When a patient avails healthcare services through a telemedicine system, the insurance claim may not cover the cost of care as it is not delivered through the traditional healthcare system. Such discrimination seldom occurs in developing countries, where health insurance is still a rare commodity (Bali, 2018).
Several types of research on telemedicine support health policies that increase access, improve population health, and remove constraints to reach patients who live in developing countries and rural areas, and align both incentives and reimbursement to support the technology necessary to deliver these services. Telemedicine has the potential for growth and adoption (Kruse, Willians, Bohls, 2021).
INTRODUCTION TO TELEMEDICINE
What is Telemedicine?
Telemedicine is simply the use of technology to connect patients, doctors, types of research, or any other participant of a medical consultation at different locations. Telehealth, on the other hand, is used to encompass a broader application of technologies to distance education, health promotion, preventive services, consumer outreach, and other applications wherein electronic communications and information technologies are used to support healthcare services (Bali, 2018).
Traditional healthcare is far more expensive in terms of indirect costs. These costs outweigh the overall affordability of healthcare services whether they are public or private. Household health care expenditure constitutes a larger share (55.4%) of total health expenditure in Nepal. This high level of health expenditure implies that health care can place a significant financial burden on households and financial protection is one of the core components of universal health coverage. Individuals can drop below the poverty level when they pay for health care at the expense of meeting their basic needs (Poudel, 2019).
Due to the convenient, efficient, and progressive nature of the telemedicine solutions existing today, the idea of incorporating telemedicine as a possible replacement for physical consultation is becoming a viable policy option for many developing countries.
According to the Facts and Factors market research report, the Global Telemedicine Market size & share revenue is expected to grow from USD 40 Billion in 2019 to reach USD 150 Billion by 2026, at a 20% Compound Annual Growth Rate or CAGR growth during the forecast period of 2021-2026. Additionally, according to the Market Data Forecast, the telemedicine market of the Asia Pacific is estimated to grow from USD 10.33 billion in 2021 to USD 27.24 billion by 2026, with a CAGR of 21.40% over the next five years.
Benefits of Telemedicine
People living the furthest from a proper healthcare facility tend to compromise with their health if the total cost of seeking treatment is significant and catastrophic. As a result, medical problems which are visible or which have led the patient to a critical life-or-death situation get priority, while others are usually ignored until things get worse. One of the most common reasons for lack of motivation to visit the nearest (free) medical facility is the out-of-pocket expenditure on health, second only to geographical limits and distance. Educated communities or communities that have received awareness via local health workers are likely to give more attention to their health, but the gap between urban and rural communities in seeking healthcare stretches in a much more convoluted manner.
That being said, telemedicine solves the obvious problem of distance and limited time. In the case of public hospitals, Catastrophic Health Expenditure or CHE is usually caused by expenses other than low-priced medical fees such as expenses of travel, lodging, food, opportunity cost, etc. which telemedicine services do not require. For a patient to conveniently use telemedicine, there is a certain investment in technology during the very beginning – the burden of which can be taken over by the local municipality. In this case, the municipality arranges the telemedicine service on its premises. Otherwise, mobile-application-based telemedicine requires already-existing technology and some digital literacy.
Health workers and nurses too can communicate with their patients once both the parties are sufficiently trained to make use of the technology. They can also serve as mediators for patients who want to consult with doctors but may not do it independently. In the case of doctors, they can communicate with patients all over the country, while being ensured that their payment channels are secure and they will be automatically reimbursed per consultation.
Since the Coronavirus Pandemic has begun, telemedicine, for many patients, has become the only way to stay in touch with their doctors and actively seek consultations.
When Telemedicine Does Not Work
Urban concerns revolve more around privacy and quality. There is no public policy related to telemedicine for the end-users, which can ensure privacy, confidentiality, and security of patient’s health information during teleconsultation.
In the case of rural communities, patients or health workers need to be welcoming of the technology without being biased. Internet speed and lack of digital literacy are some of the reasons why telemedicine won’t be accepted, let alone work.
Even if the country’s health initiatives do not rule out the importance of telemedicine, policies on the doctor’s end also need to be clear. Many practitioners fear malpractice-related legal issues, which prevents them from actively participating and developing telemedicine programs. Malpractice liability is an important barrier in the practice of telemedicine services.
Telemedicine set up can deploy varieties of information and communication technologies (ICTs) for transmitting information through texts, pictures, audio, and videos to a variety of healthcare providers. Cost depends on the type of ICT being used for the start-up. Setting an audio-visual ICT platform for teleconsultation needs huge investment. Budgetary constraints become a major barrier in the development of telemedicine networks in developing countries.
Reimbursement of telemedicine services has been reported as one of the important barriers in developed countries. When a patient avails healthcare services through a telemedicine system, an insurance claim may not cover the cost of care as it is not delivered through the traditional healthcare system. Such discrimination seldom occurs in developing countries, where health insurance is still rare (Bali, 2018).
PRACTICES IN TELEMEDICINE
International Practices of Telemedicine
Among the various countries currently drawing out their framework of how their telemedicine system should be, the telemedicine services are widely covered by the public health systems and if not, they are backed by private insurers. These countries are on their way to formulating specific laws that govern telemedicine following its unique nature in comparison to traditional consultation (DLA PIPER, 2020).
For this analysis, five countries with leading healthcare systems in the world that have identified telemedicine as an official means of healthcare consultation have been selected: Denmark, Austria, Australia, France, and Japan.
PROTOCOLS
While technically telemedicine is encouraged in Austria, medical guidelines stating that the doctor is personally and directly interacting with the patient could imply otherwise. In Denmark, innovators have adopted web and mobile applications that can assist patients to contact their local doctor, renew prescriptions and get reminders for medicines.
In Australia, telehealth medical practitioners are required to have an existing and continuous relationship with their patients. Therefore, they can only provide telehealth services to patients who have seen the practitioner for a physical consultation in the last year or have seen another medical practitioner at the same practice for similar consultation during the same period.
Telehealth service in France is divided into telecare and telemedicine. In telecare, patients interact with pharmacists and medical auxiliaries while in telemedicine the patient has a typical consultation with the doctor.
LAWS AND REGULATIONS
There are no specific laws relating to telehealth but the practices are regulated by the Danish Healthcare Act. The Danish government has additionally issued guidelines that set a benchmark for telehealth projects. It also released “Strategy for Digital Health 2018-2022” focusing on digitization in the context of prevention, care, and treatment as well as development and research in the field of healthcare.
Telehealth in Japan are subjected to the Medical Practitioner’s Act which has been recently modified as was the need during the Covid-19 pandemic. The Act on the Protection of Personal Information (“APPI”) applies to the provision of telehealth in Japan, which assures that doctors and medical practitioners are seeking consent and explaining to patients why they need specific medical information.
In Austria in 2013, the Ministry of Health established a TeleHealth Commission, Tel Gesundheitsdienste-Commission, which continues to work on improving the scope of telehealth. But there is no official list as to which type of healthcare services are provided under telehealth. At this time there is no legal framework developed specifically for telehealth in Austria.
COVERAGE BY PUBLIC HEALTHCARE SYSTEM
Countries leading in healthcare systems such as Denmark and Australia provide telemedicine services under their public healthcare system. In Japan, only telehealth services of specific areas like pediatrics and life-style related diseases are covered by public health insurance. Additionally, medical institutions are allowed to decide if they want to adopt telehealth services. The rest are mostly covered by insurance companies. Telehealth services like videoconferencing with the doctor are included under France’s public healthcare system. Since January 1, 2018, the use of telemedicine is reimbursed in the same way as a face-to-face consultationinitiative% of the conventional social security rate, with the remaining 30% generally covered by the insured person’s private complementary health insurance. In Austria, medical advice via phone or video conference is reimbursed by the public health system.
RECONSIDERATIONS DUE TO COVID-19
The Covid-19 pandemic has accelerated the use of digital systems in both public and private healthcare facilities. Given Covid-19, the French social security system covered 100% of the cost of teleconsultations from March 18, 2020, until the end of 2020. In Australia, a health insurance package known as Telehealth Determination came into force under which the treatments and consultations delivered through telehealth but were not subsidized now become eligible for subsidy. In the case of Austria, remote health advice is reimbursed through the public system but in the light of the ongoing Covid-19 pandemic, several private insurers have begun including telemedicine services in their package.
Recent Telemedicine Practices in Nepal
Recent government health strategies have been focused on strengthening Nepal’s telemedicine ecosystem.
In 2004, HealthNet Nepal conducted a pilot project for telemedicine in Nepal. It aimed to pilot the potentials of the store and forward methods in pathology, dermatology, and radiology. Om Hospital and Research Centre collaborated with Apollo Hospital in India in 2004 and started a telemedicine program. In 2010, the Ministry of Health started a rural telemedicine program in 25 district hospitals which was eventually expanded into further five districts. It provided services through the store and forward method,
video-conferencing, and hotline service “Hello Health”. In 2009, Nepal Wireless Networking Project was established by connecting a hospital in Pokhara with a health post in Nangi Village. Initiated by Dr. Mahabir Pun, he later went to facilitate municipalities like Kavre for telemedicine, along with experimenting with drones to carry medical items.
Recently an agreement was made to support Dhulikhel Hospital for Telemedicine and Health Informatics Program to serve remote and underserved communities through quality health care services, using technology and data-driven health care methods. Medic Mobile designs, builds, delivers, and supports open-source software for health workers and health systems including NGOs and INGOs in Nepal. WHO and UNICEF are supporting the piloting of the VaxTrac system that uses hand-held devices to record and track vaccinations.
Released in 2017, Nepal’s National E-Health Strategy aims to develop protocols and guidelines for implementing telemedicine services, develop user-friendly telemedicine consultation mechanisms and strengthen its services to link specialized medical experts at the central level with community health workers and volunteers.
Additionally, the 2019 Digital Nepal Framework policy includes digital health initiatives such as the National Digital Healthcare Program, Next-Generation Digital Healthcare Facilities, Electronic Health Records 2.0, Mobile Health Units, e-Maternal Care, Drones for delivery of emergency medical supplies, and Centralized Telemedicine Center.
Code of Conduct for Telemedicine Practitioners
Understanding these remote care developments, Nepal Medical Council released a Telemedicine Guideline for the registered medical practitioners in Nepal. According to this Code of Conduct, a Medical practitioner with a valid license of the Nepal Medical Council is entitled to provide telemedicine consultation to patients from any part of Nepal. Registered Medical Practitioners are expected to have been well trained in telemedicine before practicing telemedicine; Nepal Medical Council shall develop, or delegate a
A professional organization to develop, a defined short course on the practice of telemedicine, with the help of the experts working in the field of telemedicine in Nepal.
The guidelines have also set strict standards on bridging the gap felt in virtual consultations. However, it has specifically pointed out that Telemedicine should not be practiced as a substitute for conventional in-person care but should be practiced as a complimentary service where traditional in-person care is not
feasible is not accessible and is not affordable.
If the patient and/or accompanying relative is not able to understand the language, is not able to follow the guidance provided by the medical practitioner, he/she must be accompanied by the healthcare professional of the local area to interpret and guide the instructions provided by the medical practitioner.
While NMC has set its standards and the government has shown interest in strengthening this virtual healthcare package, there are relatively more efforts rolling out from the private institutions’ end. Even though their projects are following a short timeline, their impacts have become foundational and have guided us to brainstorm for Nepal’s next big telemedicine initiative.
Since the mentioned Code of Conduct advises patients to consider telemedicine as a complementary service and a necessity only when physical consultation is not possible, we cannot consider it as a true replacement for the health services that we currently have in hand.
HEALTHCARE SYSTEM IN NEPAL
Insurance Program in Nepal: Public and Private
The Social Health Security Program or SHSP acts as a Universal Health Coverage Program initiative affordable and accessible quality healthcare to all. It aims to promote pre-payment and risk pooling mechanisms to mobilize financial resources and subsidize health expenses for families identified as living in poverty, to eliminate their Catastrophic Health Expenditure or CHE. The government had announced this year that it had officially included all the provinces under this insurance program. The cost for this insurance is as cheap as USD 35 for a year for a family of up to 5 members, which individuals above 70 and those with severe and specified diseases will be provided with 100% subsidy.
Among the private insurers in Nepal, those providing medical insurance do not provide telemedicine products as of now. The number of checkups tied with the medical insurance in the policy does not specify if the checkups are supposed to be physical or virtual, but since telemedicine is still a new concept, it is understood that these checkups are physical.
The Burden of Healthcare during the Covid-19 Pandemic
Forecast of the first wave of Covid-19 in Nepal led to a nationwide lockdown in late March 2020. Ever since Nepal has been lifting and declaring lockdowns by reviewing the number of cases. 2020 left a lot of Nepalese confused and fearful, with fake news taking over the streets and people becoming more and more triggered by the day. As a result, while the first wave did not exactly challenge our healthcare channels, people suffering from non-Covid conditions did not visit hospitals out of fear, even when their health was worsening. Those who did go to the hospitals to receive treatments were sometimes ignored by hospital staff for the fear of catching Covid. Patients with long-term chronic conditions and even pregnant mothers faced untimely deaths due to this unsettling confusion and fear.
The second wave of Covid-19 which occurred around early May in 2021 did severely challenge our health system and left space for non-Covid patients to seek consultations or treatments. In both these Covid waves, we can see Nepal’s healthcare system being aggressively challenged. Patients with different degrees of health issues were scared of visiting hospitals. On the service end, while Covid doctors were working at full capacity, doctors of other healthcare problems had to take a break from their duties to make space for Covid patients. Even minor healthcare issues were not being addressed.
However, doctors and patients who had learned about recent healthtech innovations gave it a try. This year also saw an increase in the consumer base of leading digital wallet companies. We have yet to see if the habit of considering telemedicine as a substitute will be retained post-Covid. Considering the practices and responses in other countries, retention is likely to be low, since insured patients will favor hospital visits if telemedicine services are not being reimbursed and are not considered equivalent to a physical hospital. Therefore, while the crisis did favor innovations, post-crisis consumer behavioral patterns can bounce back to their original state.
CONSIDERING TELEMEDICINE UNDER PRIVATE INSURANCE
Inclusion of Telemedicine in Private Insurance
In the context of Nepal, telemedicine is technically not up to the benchmark to be able to replace a normal, regular visit to the doctor. If telemedicine is treated as a complementary service, that would have two extremely different impacts on the urban and rural communities. Urban communities who have covered by the health insurance would not bother investing in additional services while the uninsured would fear the risk of catastrophic health expenditure that may befall upon them and thus they would not be interested in accumulating any more fees. Rural communities will not consider complimentary services when even basic healthcare isn’t very easy to receive.
If the government considers establishing a proper telemedicine facility, that would require additional investments in technology, infrastructure, and training. Over the years, while the national health strategies have continuously highlighted the need for telemedicine, a specific model for it hasn’t come into action. As a result, rural healthcare is running on whatever means possible, but telemedicine approaches have never truly been a national, long-term priority. However, running a public telemedicine facility would remove the burden of cost from the rural communities’ shoulders.
Narrowing down the exact problems in the evolution of telemedicine, we are severely lacking investments in the overall industry. Over the past years, we have seen many telemedicine projects initiated by private bodies for a certain period. Hospitals, health facilities, and ICT experts have shown more enthusiasm in building telemedicine platforms and providing healthcare consultations through convenient platforms than the government. Therefore, it is likely that private institutions will eventually show interest in adopting long-term telemedicine technologies. When non-covid patients are avoiding hospitals, doctors and medical experts of all other kinds of health issues will have no choice but to remotely provide consultation in whatever way possible. This is where recent telemedicine technologies, whether mobile and website-based, have come in handy to bridge the gap.
This shows that no matter how much thought we give to the telemedicine industry, our demands for it do not shrink. Through whatever means possible, we rely on telemedicine. Be it in a rural community or a pandemic scenario, we need to reach our doctors anyhow. In specific times or places, it stops becoming a choice and starts to become a necessity.
Desired Outcome and Expansion of Healthcare
Reimbursable telemedicine services are cheaper and convenient to deliver. If insurers do include telemedicine in their overall medical insurance package, then depending upon the platform of the telemedicine, middlemen can be cut and teleconsultations can be provided directly by doctors on verified consultation platforms. For example, seeking teleconsultation through a mobile application allows the doctor to be paid as per their demand, without having to register as a patient, much like when we normally visit a hospital. Teleconsultation, therefore, becomes accessible and affordable, making it easier to be included in the already existing healthcare insurance plans.
Even though it is a complimentary service, when consumers are reimbursed for each teleconsultation by their private insurers, they will have more incentives to seek medical checkups if they weren’t seeking it before. This applies to lower-middle and middle-income families, who are digitally literate but cannot always afford to go to the doctor when they face any health problems. It allows them to ask several questions about health issues that they were previously ignoring. Doctors in teleconsultation can also assess patient’s reports and provide prescriptions while helping the patient to maintain digital records of the session. On the insurer’s end, the validity of the consultation and service can thus be regulated through these maintained digital records.
The surest way to make any mode of teleconsultation much cheaper is through ICT investment. The right investment in technology can make telemedicine services more compact, comprehensible, and convenient. This will also lead the insurers to educate their consumers about the digital possibilities of the telemedicine packages.
As for the low-income families, since they are covered by the national health insurance program already, the best way to include them in reimbursable telemedicine packages would be when the government decides to invest in “tried and tested” telemedicine technologies that have been verified or backed up by the private insurers. This way the government can pool the ICT resources at a national level, thus reducing the scale of investment in intangible resources and strengthening healthcare channels.
POLICY RECOMMENDATION
In light of the recent pandemic, we are more than aware of the fact that our healthcare system needs to be expanded and upgraded. Observing the current technical capabilities of healthcare innovations, we require solid medical insurance policies that allow the insured to access virtual healthcare consultations. Being insurance policies, Rastriya Beema Sansthan, the official regulator for the insurance companies of Nepal needs to direct their attention towards adding some telemedicine features to existing health policies.
Keeping in mind the identification of telemedicine in Nepal as a complementary service by the Nepal Medical Council, its service needs to be specified and therefore added to the existing policies and recognized as “ineligible as a replacement for a physical consultation”. The nature of telemedicine also needs to be specified: is it operated via telephone, videoconferencing, or simply over the internet? How much would the insured have to pay to receive the consultation? Would they need simply a phone? Or would they need a smartphone, certified applications, and a good internet connection? Would the insurance also cover these costs? How will the insured be assisted in learning about the particular telemedicine operation?
To begin the demand for telemedicine services, insurance companies can provide a limited number of free telemedicine services in their existing policies with an additional fee for each additional teleconsultation.
Institutions that are running these telemedicine services, whether public or private need to be officially certified by the insurance companies as “eligible to provide reimbursable telemedicine services”. To ensure the smooth flow of certification, starting a telemedicine board is recommended.
Under the current telemedicine services, the clusters telemedicine providers have not been systematized properly. Therefore, even doctors or other consultants need to be included in a formal loop that can recognize them as official telemedicine providers and then provided them the required insurance policies accordingly eg. telemedicine malpractice insurance.
Finally, once the demand for privately insured telemedicine services rises, Rastriya Beema Sansthan can recommend similar policies to be added to the national insurance program which currently has nationwide coverage.
Upon making these policy changes, existing telemedicine services will have incentives to work upon their current services and improve them for insured users. The new policy will be financially reliable and they will be able to participate in a market that is far more competitive and excelling in terms of quality.
