In our previous article of this series, we discussed health data protection and how digital/electronic health records could facilitate the success of Telemedicine systems (link). We also discussed in our Telemedicine Series that pharmacies are among the key stakeholders of the overall telehealth and telemedicine systems and an accelerated move towards having them certified and authorized to dispense drugs should definitely be the path forward (link). This is mainly because, apart from helping ease hospital overcrowding, there are other indirect benefits such as (i) reducing patients' costs of travelling to hospitals; (ii) enabling doctors to use their time more efficiently; and (iii) improving patients' quality of life and reducing indirect economic loss caused by time spent visiting a doctor.
In this article we would like to highlight how the insurance industry can facilitate the ideal scenario mentioned above. This is an elaboration of what we discussed earlier on the importance of health or medical insurance for the success of telemedicine (link).
Telepharmacy - Telemedicine accelerator
The Ministry of Public Health through the National Health Security Office (NHSO) has launched a trial model in cooperation with 500 pharmacies for patients under the Universal Medical Scheme (Gold Card Scheme). Under this model, the patients will take medical prescriptions from their doctors and purchase prescribed drugs from one of the said 500 pharmacies in the trial model (https://pr.moph.go.th/?url=pr/detail/2/04/139582). The pharmacies will be reimbursed by the relevant government agencies, in this case, the NHSO.
This system has been implemented in many countries, including the UK and USA. According to Dr. Sakchai Kanjanawatana, Secretary-General of the NHSO, this model will soon be expanded to both the Civil Servant Medical Benefit Scheme and Social Security Fund.
Telemedicine needs to go hand in hand with medical insurance
It is not clear if the above model is planned to also cover telemedicine. However, with the many benefits of telemedicine and the likelihood of telemedicine being accepted and implemented in the near future (link), the trial reimbursement model mentioned above should naturally apply to telemedicine as well. Development in this direction is expected, considering that insurance legislation and regulations do not have any specific limitation to the possibility of extending the coverage under medical policies to telemedicine. The Office of Insurance Commission (OIC) has always encouraged insurance companies to create new products, in spite of the fact that Thailand will become a full-fledged ageing society as the number of people aged over 60 years old will rise to 20 percent of the total population by 2021. The OIC’s current Insurance Development Plan (No. 3) 2016-2020 indicates clearly that the OIC promotes health insurance products. Even though the Plan will be ending this year, we understand that the OIC’s new policy and new plan will continue to support health insurance businesses and products.
When all infrastructure and relevant guidelines are in place, it is highly likely that the NHSO will extend the Gold Card coverage to telemedicine. The more difficult question will be to what extent the coverage will be.
Race for business opportunities
Private insurance companies should also consider using the same criteria as the NHSO to extend their medical policies to cover expenditures from telemedicine. At this point in time, as the guidelines on telepharmacy are still being drafted and the guidelines on telemedicine, issued by the Medical Council (to be effective on 20 October 2020), are vague and depend largely on many other regulations and guidelines issued by both other government agencies and professional associations (e.g. pharmacists and nurses), for insurance companies to be able to prepare themselves for potential new products or an extension of their current policies, various financial factors and economic potentials have to be considered before one moves into the new territory. Interestingly, as the legal requirements and the landscape of telemedicine differ from one country to the next, the experiences of another country might not be very useful here. Therefore, it is important to answer the questions below:
- Would the telemedicine policy include online consultations?
- Would only follow-ups via telemedicine after the first physical visit (when a physician and patient relationship is first established) be covered?
- Would only interactive telemedicine be entitled to reimbursement?
- Would "store and forward" be included in the insurance coverage?
- Could the purchase of medicines from certified pharmacies be reimbursed?
While it seems that we have a chicken and egg situation before us, since the government’s guidelines still require clarification and some of the above questions may be best answered after these rules are clear, it is always the case that those who are willing to move ahead faster are likely to be in a better position to gain a competitive advantage when all requirements are established.
Certainly, telehealth/telemedicine is not something new and the current pandemic we are facing is not going to change the fact that we still need to build up this system further. However, it seems that COVID-19 has, as it has done with so many things around us, accelerated the implementation of telemedicine. Therefore, other elements will have to move faster as well and there is no exception for health insurance businesses.