The emergence of the new health care consumer - Part 1: Health Care Futures - Panel Discussion

Physician Executive,  May-June, 1998  by Robert P. Carlson

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We know, too, that the cost of video-conferencing or doing any of these other things used to be so high and the cost of going online is now coming down so fast that over the next five years it'll be almost free, not quite, but close, to put in Internet connections in the home. The devices themselves and the bandwidth will be much, much cheaper, and there's going to be improvement in access to technology from that.

And the third piece which we haven't really touched on yet, but is very, very important, is that for disease management and chronic care management, monitoring patients when they're well is the key to stopping them from getting sick. Greg, your company knows very well that diabetics, if they keep to their regimen and do the things they're supposed to do, stay basically okay. It's the ones who fall off that path who end up in the emergency room.

What the Internet and other communication devices are going to be able to do over the next five to 10 years is be attached to all kinds of sensors which are going to be attached to people. Sensors will be attached to their medicine chests, attached to their insulin to see whether they took it or not, and attached to these people themselves. We'll then really be figuring out what's going on with those individuals when they're at home. There will be an increased amount of tracking of all of that. Communicating via the Internet and other types of media is going to really change the way people think about managing the chronically ill.

Reinhardt: The way we do home care now is actually very primitive. We don't even check who these people are or if they have criminal backgrounds and they're invariably not well trained. When the parents of the fairly well-to-do layer of yuppies, whatever it is, 30, 40 percent of the population, are getting older, they may feel much more comfortable having machinery at home that constantly monitors their parents. I've seen such equipment already that feeds that information via the Net to a clinic or to a hospital and alerts them when intervention is necessary. I agree that home care will be totally changed by the Internet and whoever can grab that business, whether it's hospitals or medical clinics, is going to be well positioned.

The other thing that I always thought the Internet would do is globalize health care. Given that American physicians are ranked second to none, I think the U.S. is very well positioned to give medical advice to a lot of people all over the world, but I'm not enough of an expert to know how you charge for this. How could you make a living of it? American physicians are so damned good and the world needs them and what they know, so how could there be a surplus of them?

Rippen: Actually, they are using them in Saudi Arabia via telecommunications. All good medical centers have certain countries that they link to give them an expert opinion.

Reinhardt: It's already happening?

Rippen: Yes, but for countries that have money.

Reinhardt: I'm not expert enough on the economics of billing for that, but you could imagine a first rate physician who could spend half time attached to a clinic, but the rest of the day actually export health care advice for money all over the world.