Although billing systems for telephone consultations have been developed and put in place in several countries in Europe and North America, presently in Argentina they are practically non-existent. Various aspects of the contemporary healthcare system, professional training, current fees and the proliferation of mobile telephones and overall connectivity have led to increasing use of the telephone as a therapeutic tool. Faced with demand for this sort of care from the population, doctors have opted to monitor progress of symptoms and even treatments via mobile devices. This move in favor of the patient’s comfort does bear a risk given that it is impossible to be certain of a diagnosis without a physical examination but this risk can be reduced if the telephone consult is used for monitoring or simply to convey results rather than requiring the patient to visit the doctor in person.
The extensive connectivity which makes it possible to keep up to date with the activity of an enormous portion of the population has not yet been used as an asset by doctors in their daily practice. Can finding out about a teenager’s movements through their Facebook page be used as a psychological tool when treating a psychological disorder? Would an email to the smartphone of a pregnant woman who can’t make an appointment help or hinder her prenatal care?
An important point to consider is professional fees. Many of the practices mentioned are not considered medical practices, being seen instead as a simple consequence and benefit (or hindrance) of being connected with patients in different ways in addition to the basic clinical appointment. This means that they are not considered a medical act and thus that the professional should not request payment.
Since September of this year, a company has been providing a service in Argentina which allows doctors to bill for the work they do over the telephone.
The system is based on withholding private numbers and instead making use of a call center to make the company (ConsultaMás) into an intermediary which allows the doctor to bill for the call. This kind of system is widely used in the United States, where it would be unthinkable for a professional to answer their mobile phone for a consult for free. However, it is important to note that healthcare in that country is organized differently and that the regulations, especially for medical insurance which is not accessible to the entire population, create an ideal environment for the development of pre-paid telephone companies (Tell-A-Doc, amongst others). In Europe, particularly in France, telephone resources are used for daily consults to complement physical visits and billing through intermediary companies creates more incentive for the professional to make use of their mobile phone as a resource (A2billing).
New procedures like these have initially met with resistance in Argentina, and even though many clinics may eventually adopt the product, in some cases as a resource that allows them to differentiate themselves from others by offering their affiliates a new product, they are still viewed with suspicion. In other cases, although these systems could serve as a generator of extra health resources, providing the medical coverage desired, the sensation of exaggerated commercialism might also limit their wider adoption.
If the system is conceived of as being designed to prevent abuse through overuse by patients and, on the other hand, abuse through overbilling by doctors, many more professionals will be tempted to offer their mobile phone as an alternative to sending patients to the emergency room on the first signs of pain.
It remains to be seen how the financial directors of health services will adopt the new system, although it will probably make it possible to lower costs in the medium term especially by limiting unnecessary visits to emergency rooms, hospitals or medical clinics.
