The pandemic spurred an enormous increase in telehealth—providers treating patients via remote communications, such as video chats. I often assert that telehealth will lower costs and raise the quality of care. Recently, an astute public official asked me whether data exist to prove this—and whether polls exist indicating that people really want to use telehealth. Great questions.
My answer has three parts: Mainstream telehealth is too new to measure its eventual impact on cost and quality—but we can intuit possibilities. Asking people today whether they want telehealth in the future is as meaningless as asking someone in 1995 whether they wanted an iPhone. And cutting costs isn’t the same as reducing spending.
The cost-cutting possibilities of telehealth are many. Physicians seeing patients through screens need less physical plant and smaller staff than those seeing patients in person. Telehealth physicians can live in low-cost parts of America and still serve those in high-cost regions. With around-the-clock access, telehealth patients can seek earlier treatment, often meaning an inexpensive fix now rather than an expensive fix later. And communities experiencing temporary peak-load demand for care can tap into a national pool of providers with shared costs. And for quality, the pandemic year has shown us areas of treatment, like behavioral health, where remote care can be even better than in-person care. But as for data, while telehealth arguably began in the 1870s, it was a tiny niche service until 2020.
Will people want more telehealth in the future? We can look at information technology (IT) trends for hints. Apple CEO Tim Cook said, “Our whole role in life is to give you something you didn’t know you wanted. And then once you get it, you can’t imagine your life without it.”
In 1940, many Americans didn’t like the idea of dialing their own phone calls. Many were fearful that rotary dial technology would be too complex and confusing. For this reason, the Bell Telephone System produced a 20-minute video infomercial to calm skeptics’ nerves. Of course, as soon as rotary dial phones were installed, virtually nobody wanted to go back to an operator asking, “Number, please?”
A Canadian business leader (and visionary) once told me that in the late 1990s, two entrepreneurs showed him a product they were developing. They said it would combine a cellphone with an internet browser, a notepad, and a calendar. The business leader’s reaction was bemusement—and maybe a touch of pity. Why, he thought, would anyone ever wish to cram all those things into one device when they work so well separately? What his two visitors had invented was the BlackBerry, to which millions were soon addicted. Before the BlackBerry was actually on the market, a poll asking whether people wanted such a device would have been meaningless. Asking 1995 denizens whether they would like a device with today’s iPhone’s capabilities would have yielded only bewilderment and bemusement.
With coming advances in remote telemetry and diagnostics, population databases, and artificial intelligence, telehealth in 2046 will be as different from telehealth in 2021 as an iPhone X is from a mid-90s flip phone. And patients’ and providers’ perception of telehealth has already undergone a sea change since COVID’s ravages began.
Finally, it’s crucial to understand that while telehealth will likely lower the unit costs of treatment, that in no way ensures that it will reduce aggregate health care spending. Returning to IT, over the past 50 years, the cost of computing power has probably dropped faster than the cost of any other good in human history. The computing power of a single iPhone would have (in theory) cost trillions of dollars in the 1950s. But despite this plunge in cost, we spend more on electronics than ever. We’re just getting vastly more out of each dollar we spend. Health care may proceed similarly. As technology lowers the cost of improving health, we may decide collectively to spend even more than we do now.
It will be an interesting ride, but no statistics or tea leaves today can show us the future. As the Magic 8-Ball says, “Reply hazy. Ask again later.”
