摘要
背景：大流行期间，远程医疗的使用呈指数级增长，这凸显了量化远程医疗对总体医疗成本影响的必要性。虽然大流行阻碍了所有美国人获得亲临现场的医疗服务，但对于某些人群来说，获得医疗服务仍将是一项挑战。目标：我们试图通过回顾 2020 年 2 月至 9 月间全美 140 万次远程医疗就诊的数据集来评估远程医疗的成本效益。方法：回顾性分析使用了来自六个大型医疗系统和一个州医疗补助机构的数据。经济模型考虑了直接和间接成本。结果：本文以远程医疗和电子医疗法中心 2021 年发布的报告为基础，对数据集中远程医疗就诊人次最多的六个州进行了分析。研究显示，远程医疗节省了大量成本。除一个大都市地区外，远程医疗在医疗保险（Medicare）和医疗补助（Medicaid）方面分别降低了 44.5 万至 3300 万美元和 15.5 万至 1.81 亿美元的成本。成本节约是基于最常见的诊断：行为健康、癌症、心脏病、肺部疾病和内分泌失调。局限性：由于使用了会诊数据，因此无法对患者纵向使用远程医疗的情况进行分析。每次就诊都被视为一次独特的观察。虽然数据集代表了全国范围内远程医疗的使用情况，但根据现有数据，有些州的代表性过高，而有些州的代表性不足。最后，对于六个医疗系统而言，数据仅限于医疗系统所覆盖的地区。因此，在某些州，大多数就诊都发生在大都市地区。结论远程医疗通过增加医疗保健 452244 服务的可及性，尤其是对于受患者附近医疗服务提供者短缺直接影响的病症，可以节省大量成本，尤其是在医疗补助计划中。Background: The exponential growth in the use of telehealth during the pandemic underscored the need to quantify how telehealth impacts overall health care costs. While the pandemic inhibited access to in-person care for all Americans, access to care will remain challenging for some populations. Objective: We sought to assess the cost-benefit of telehealth by reviewing a data set of 1.4 million telehealth encounters across the United States performed between February and September 2020. Methods: A retrospective analysis used data from six large health systems and one state Medicaid agency. The economic model considered both direct and indirect costs. Results: Building upon a report published in 2021 by the Centers for Telehealth and eHealth Law, this article presents an analysis of the six states with the highest telehealth encounters within the data set. The study revealed significant cost savings. Telehealth was associated with a reduction in costs ranging from $445,000 to $33 million for Medicare and $155,000-$181 million for Medicaid, except for one metropolitan area. Cost savings were based on the most frequent diagnoses: behavioral health, cancer, heart disease, pulmonary conditions, and endocrine disorders. Limitations: The use of encounter data prohibited the analysis of a patient's longitudinal use of telehealth. Each encounter was treated as a unique observation. While the data set represented telehealth use across the nation, some states were over-represented while others were under-represented, based on available data. Finally, for the six health systems, data was restricted to the regions covered by the health system. As such, in some states, most encounters take place in metropolitan areas. Conclusion: Telehealth can generate significant cost savings, particularly within the Medicaid program, by increasing access to health care452244 services, especially for conditions directly impacted by provider shortages within geographic proximity to the patient.
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