By Femi Obikunle
The innovation through the use of telemedicine has afforded new ways of medical consultation by healthcare practitioners. This article focuses on important issues in telemedicine consultation and how best insurance industry can work with other stakeholders involved in healthcare delivery through the understanding of salient issues to provide feasible solutions that would ensure an effective and efficient healthcare delivery system within Nigeria, and across international borders.
No doubt, telemedicine is changing the way medical practice delivers healthcare and its exponential evolution all over the ecosphere is raising new questions about the application of traditional insurance plans to this new delivery system. Telemedicine as the latest frontier combines the traditional healthcare with the effectiveness of present telecommunications knowledge to deliver healthcare nationally and internationally.In addition, Telemedicine which is sometimes referred to as telehealth services involves the remote diagnosis and treatment of patients through telecommunication technology. Telemedicine seamlessly allows patients to access medical expertise quickly and efficiently without the need to travel
Telemedicine services can be easily used for a number of non-emergency situations such as diagnoses of common medical problems such as allergies, asthma, bronchitis, cold, or flu, ear infection, pinkeye, rashes, digestive problems, and many other issues.
Some of the potential benefits of telemedicine include increased access to health care (especially in underserved areas and among underserved populations), expanded utilization of specialty expertise, system coordination and integration, ready availability of patient records, and reduced opportunity costs of long – term care for patients.Insurance, on the other hand, is not new to the Nigerian public, and institutions for practitioners and regulation of the insurance are long in existence and are still thriving.
The likely emergence of telemedicine as the new frontier of medical practice worldwide calls for a pragmatic review of extant insurance law and regulatory guidelines as new insurance products and policies must drive the new game changer. Nigeria and other developing countries which are yet to latch onto the telemedicine initiative have unique advantages of upgrading successful implementation strategies of telemedicine by some developed countries.
A typical potential telemedicine patient by profile may already have been familiar insurance policies. The following insurance for telemedicine service providers exist (with subtle change in name to reflect local realities and practices) in North America, Europe and Asia:
- Equipment/Property Insurance
- Loss of Profit Insurance
- Fidelity Insurance
- Malpractice Insurance
- Professional Indemnity Insurance
It is beyond the scope of this article to dwell on the merits and or demerits of any of these insurance plans. Suffice it to posit that Nigeria would do well to review, and adopt those relevant for current practice and future development. Though the list is dynamic, I shall focus on health insurance and long-term care insurance. The idea is to assist the patient and other stakeholders navigate the technicalities of telemedicine insurance. The current Health Maintenance Organization (HMO) Guidelines applicable in Nigeria should be modified for telemedicine as follows:
- Where certain procedures are covered by the service provider, a parity law must exist for the same procedure to be rendered under telemedicine practice at the same premium or slightly adjusted premium.
- Certain procedures can only be provided under telemedicine practice. How this will affect existing premium should be considered.
- Under HMO, portability of service provider is allowed; the same must be applicable under telemedicine practice.
- Issue of non-rendition of capitation to a participating hospital or clinic and late payment of vetted bills submitted by them may curtail the effectiveness of telemedicine practice as some hospitals, clinics, research pharmacies and physicians may be foreign- based.
- Participating insurance companies must be pre-selected based on rigorous criteria and the areas of coverage must be delineated to ensure that only qualitative insurers are key participants in Telemedicine practice.Effective sanctioning of erring participants should be implemented without fear or favour.
- Enforceable guidelines must be in place for Re-insurance of telemedicine insurance because of the international dimension of telemedicine practice.
- Copay Insurance plan may be feasible where after an employer premium payment, any hospitalization, medication and surgery bills are apportioned at agreed percentage between the patient and the insurance company. Another alternative is for the insurance company to foot the entire medical bill.
- The issue of unassessed treatment where annual premiums have been cumulatively paid should be carefully considered.Should such premiums be carried over, or a certain percentage refunded?
My next article will focus on the impact of Malpractice Insurance on Telemedicine practice.
Conclusion and Recommendations
The Insurance Companies, Chartered Institute of Insurance of Nigeria (CIIN), Nigeria Insurance Association(NIA), National Insurance Brokers Commission (NIBC), National Insurance Commission (NAICOM) and the Federal Ministry of Industry, Trade and Investment being critical stakeholders in all insurance matters should collaborate and synergize their competencies to birth a healthy insurance framework for the successful implementation of Telemedicine, if and whenever, the nation adopts the golden route to the future of medicine.Well-coordinated efforts with the National and State Assemblies should be made to produce workable:
- Blueprint for the Adoption of Telemedicine in Nigeria Guidelines for the Practice of Telemedicine
- The Nigerian Telemedicine Act/Law 4Telemedicine Curriculum for Medical Education and Training