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Introduction: Residents of Northern Ontario have limited access to local psychiatric care. To address this, three program models exist: (1) telepsychiatry; (2) psychiatrists traveling to underserved areas; and (3) reimbursing patients for travel to a psychiatrist. Evidence shows that telepsychiatry has comparable outcomes to in-person consultations. The objective of this study was to determine the cost difference between programs., Methods: A cost-minimization analysis estimating cost per visit from a public healthcare payer economic costing perspective was conducted. Data on fixed and variable costs were obtained. Evidence-based assumptions were made where relevant. Base-case scenarios and a break-even analysis were completed, as well as deterministic and probabilistic sensitivity analyses, to explore the effects of parameter variability on program costs., Results: Costs per visit were lowest in telepsychiatry (CAD$360) followed by traveling physicians (CAD$558) and patient reimbursement (CAD$620). Among the 100,000 Monte Carlo simulations, results showed telepsychiatry was the least costly program in 71.2% of the simulations, while the reimbursement and outreach programs were least costly in 15.1% and 13.7% of simulations, respectively. The break-even analysis found telepsychiatry was the least costly program after an annual patient visit threshold of approximately 76 visits (compared to traveling psychiatrists) and 126 visits (compared to reimbursed patients)., Discussion: Our analyses support telepsychiatry as the least costly program. These results have important implications for program planning, including the prioritization of telepsychiatry, increased integration of telepsychiatry with other modalities of outreach psychiatry, and limiting use of the patient remuneration program to where medically necessary, to reduce overall cost.

Many healthcare workers are "on the road" traveling to and from fixed sites (eg, patients'/clients' homes). Qualitative interviews with nine Nova Scotian managers of mobile healthcare workers explored the conditions of workers' travel. Findings highlight challenges such as changing schedules, as well as positive features including flexibility over the travel schedule. Some managers noted worker mobility-related responsibilities including having to decide if travel is too dangerous due to poor weather. A few managers suggested that workers may not receive adequate economic reimbursement for travel costs (eg, wear and tear on vehicle), and in some instances, workers need to use a benefit (eg, vacation day) or are not paid if they cannot drive due to poor weather. Reported organizational supports for workers' travel were variable. This research indicates a need for supportive mobility-related policies and practices across all organizations, including policies that cover economic costs related to travel for all workers.

Introduction: The delivery of specialist health services to people living in Indigenous communities is an important challenge. Specialist diabetes outpatient clinics may be delivered via a patient travelling to a metropolitan hospital, during an outreach clinic, or by telehealth. The aim of this study was to compare the costs and consequences of different service models for delivering specialist diabetes clinics for a remote Indigenous community., Method: Patient travel, outreach and telehealth clinic models were compared using a cost-consequence analysis principles. The setting was Cunnamulla, a remote Indigenous community in Western Queensland. Costs were calculated by quantifying the staff resources and travel costs for each clinic model. Costs were reported in Australian dollars and reported from the health service perspective., Results: The marginal cost per patient for each clinic were $692 for patient travel, $482 for the outreach and $284 for telehealth. If a patient travel appointment was replaced with telehealth, approximately $517 in costs for patient travel reimbursement would be avoided. While replacing an entire outreach clinic with a telehealth clinic would reduce costs by approximately $3961., Conclusion: The marginal cost of patient travel to a metropolitan clinic and outreach clinic appointments was greater than telehealth. Telehealth is unlikely to completely replace the need for patient travel or outreach clinics. However, replacing a proportion of these appointments with telehealth may reduce the overall costs of providing specialist diabetes care in remote communities. Telehealth may have advantages beyond economic as it reduces the time away from usual activities for both the patient and endocrinologist.

Introduction: In this paper the economic costs associated with a growing, multi-state telepsychiatry intervention serving rural American Indian/Alaska Native populations were compared to costs of travelling to provide/receive in-person treatment., Methods: Telepsychiatry costs were calculated using administrative, information-technology, equipment and technology components, and were compared to travel cost models. Both a patient travel and a psychiatrist travel model were estimated utilising ArcGIS software and unit costs gathered from literature and government sources. Cost structure and sensitivity analysis was also calculated by varying modeling parameters and assumptions., Results and Discussion: It is estimated that per-session costs were $93.90, $183.34, and $268.23 for telemedicine, provider-travel, and patient-travel, respectively. Restricting the analysis to satellite locations with a larger number of visits reduced telemedicine per-patient encounter costs (50 or more visits: $83.52; 100 or more visits: $80.41; and 150 or more visits: $76.25). The estimated cost efficiencies of telemedicine were more evident for highly rural communities. Finally, we found that a multi-state centre was cheaper than each state operating independently., Conclusions: Consistent with previous research, this study provides additional evidence of the economic efficiency associated with telemedicine interventions for rural American Indian/Alaska Native populations. Our results suggest that there are economies of scale in providing behavioural telemedicine and that bigger, multi-state telemedicine centres have lower overall costs compared to smaller, state-level centres. Additionally, results suggest that telemedicine structures with a higher number of per-satellite patient encounters have lower costs, and telemedicine centres delivering care to highly rural populations produce greater economic benefits.

Objective: The purpose of this study was to model the cost of delivering behavioural health services to rural Native American populations using telecommunications and compare these costs with the travel costs associated with providing equivalent care., Methods: Behavioural telehealth costs were modelled using equipment, transmission, administrative and IT costs from an established telecommunications centre. Two types of travel models were estimated: a patient travel model and a physician travel model. These costs were modelled using the New Mexico resource geographic information system program (RGIS) and ArcGIS software and unit costs (e.g. fuel prices, vehicle depreciation, lodging, physician wages, and patient wages) that were obtained from the literature and US government agencies., Results: The average per-patient cost of providing behavioural healthcare via telehealth was US$138.34, and the average per-patient travel cost was US$169.76 for physicians and US$333.52 for patients. Sensitivity analysis found these results to be rather robust to changes in imputed parameters and preliminary evidence of economies of scale was found., Conclusion: Besides the obvious benefits of increased access to healthcare and reduced health disparities, providing behavioural telehealth for rural Native American populations was estimated to be less costly than modelled equivalent care provided by travelling. Additionally, as administrative and coordination costs are a major component of telehealth costs, as programmes grow to serve more patients, the relative costs of these initial infrastructure as well as overall per-patient costs should decrease., (© The Author(s) 2015.)

In our previous study, in 1997, we evaluated the cost of teleconsultations in a primary care centre compared with the cost of the conventional alternative, travelling to the hospital. The results showed that teleconsultations were cheaper than patient travel when the annual workload was more than 110 patients in ophthalmology and 115 patients in dermatology. Using the same method of analysis for 2009 data showed that cost savings would occur if the annual workload was 20 patients in ophthalmology and 17 patients in dermatology. The main differences between the two studies are the reduced cost of the technology (which was based on PCs in 2009) and the increased cost of staff. Both studies show that teleconsultations can be cost-effective in a relatively small health centre. The cost of technology continues to decrease, although the other costs in our break-even analysis continue to increase. However, the usability of technology continues to improve, and this will make telemedicine a more attractive alternative in the future.

The aim of this research has been to make a contribution to deliberations concerning the relative costs of provision of domiciliary services for the elderly in local authorities in England and the implications for funding. The main services considered have been day-centre services and home-care services, and the particular cost areas investigated have been travel-related costs as associated with distances travelled by day-centre vehicles and care workers and with worker travelling hours. These costs are influenced by the population settlement and dispersion characteristics of the areas served and funding mechanisms are needed (and are in place) to compensate service providers. However, current mechanisms have been widely criticized and the research reported here reaches conclusions about whether such criticisms are justified and how improvements might be brought about. The methods used have involved detailed operational modelling of the selected services in a sample of local authority areas and the generalization of the findings to England as a whole.

We have conducted a feasibility study to establish whether ENT tele-endoscopy would be a suitable method of service delivery for patients who live in the Shetland Islands. Ten clinics were conducted over a period of 17 months using ISDN-based videoconferencing at a bandwidth of 384 kbit/s. A total of 42 patients were seen in Aberdeen via videoconferencing for a head and neck cancer assessment. Feasibility was confirmed after the first 20 patients, following positive feedback from all concerned and the absence of any significant clinical or technical problems. A total of 42 journeys was avoided, each journey saving 123 kg CO(2) per person. A preliminary cost analysis showed that the threshold at which tele-ENT became cheaper than travel was a workload of 35 patients/year. The actual workload during the pilot study was 29 patients/year. A national telemedicine service for the initial assessment of potential malignancy has the potential to reduce unnecessary transfers to specialist centres, with accompanying reductions in carbon emissions.

A recent report on cancer services in Wales recommended an integrated cancer service. The proposed model was difficult to introduce in rural areas, where health-care sites and staff are far apart. Videoconferencing equipment was installed in the Singleton Hospital, Swansea, and the Bronglais General Hospital, Aberystwyth, 120 km away. During the first year, 42 videoconferencing multidisciplinary team meetings were held using ISDN at 384 kbit/s. A total of 202 cases were reviewed. The cancers were colorectal, breast and lung. There was only one aborted session, which was due to an ISDN line fault. The average attendance at the meetings was 15 staff, of whom eight were essential team members. Regular multidisciplinary team meetings reduced the need for patients to travel. They also increased access to expert opinion and reduced the delay in implementing treatment.

We assessed patient satisfaction with the use of telemedicine in rural California, in comparison with usual face-to-face care. A standardized patient satisfaction questionnaire was developed using a five-point scale to measure dimensions of care in a telemedicine environment. Twenty-four primary care sites in 18 Californian counties submitted satisfaction data. The patient response rate was 61% (n = 793). Consultations were provided in 27 specialties. The responses to the questionnaires indicated that telemedicine made it easier for patients to receive specialty care (91% of patients satisfied, mean score 4.6). There was general satisfaction with telemedicine (87%, mean 4.5), a willingness to continue receiving services (90%, mean 4.6) and most patients felt that they would not receive better care in person (61%, mean 2.3). Patients stated that they received the necessary information from specialists (85%, mean 4.5) and had their questions answered by a primary care provider or nurse (89%, mean 4.7). Seven hundred and forty-one patients submitted travel information. There was an average decrease in travel distance of 170 km and time savings of 130 min using telemedicine. The average cost of travel to a specialty appointment was $83 (n = 310). The present study suggests that telemedicine is acceptable to patients as a method of improving access to specialty expertise, and compares favourably with face-to-face care.

We studied advice given by travel agents, the experiences of recent travellers, and the hidden costs for travellers to Kenya. There was a wide range of advice given by United Kingdom travel agents, much of it at variance with advice given by other travel agents and much of it incorrect. Nevertheless travel agents have a responsibility to give advice because they are often the only point of contact for health advice.

Objectives: To assess the importance of the private costs incurred by patients when making a judgment on the economics of screening for abdominal aortic aneurysm (AAA), and to explore the variation in such costs depending on screening location., Setting: A district general hospital and general practitioner surgeries., Methods: Four hundred and ninety nine consecutive subjects attending for AAA screening completed a questionnaire asking about travel arrangements for the journey to and from the clinic, the distance travelled, the time taken, the mode of transport, and any out-of-pocket expenses incurred. In addition, at the clinic each subject was asked what activities they had forgone in attending the clinic. Time was valued differently depending on whether work or leisure activities were forgone. The total private cost for each attender was calculated and comparison was made between attenders at hospital and at general practice., Results: A significantly greater proportion of subjects were accompanied when attending hospital than when attending general practitioner (GP) surgeries. Most attenders travelled by car, but the journey time was significantly longer for those visiting hospital. The expected total private cost associated with attendance for AAA screening was 5.47 pounds. Attendance at GP surgeries had a lower private cost (4.21 pounds) than attendance at hospital (6.87 pounds). Only 7.3% of all men surveyed, and 6.5% of all companions, would have been taking part in some form of paid occupation if they had not attended for screening., Conclusion: Despite the fact that most attenders for AAA screening will be retired, the associated private costs are appreciable and should be considered in assessing the economics of such screening programmes. The level of private costs varied depending on the location of screening; clinics held at GP practices had lower private costs than those held at hospital.