House calls used to be at the very heart of a GP’s practice, but at some point in the past few decades economic forces made them largely obsolete. Now they may be back, thanks to what many are calling the “uberisation” of medicine.
In several large cities in the United States, new app-based services have made calling in a doctor or nurse to your house or workplace as easy as getting an Uber ride.
Take, for example, the Los Angeles-based start-up Heal, which says it has treated as many as 12,000 patients since its launch in 2015.
Heal came about after its co-founder, nephrologist Dr Renee Dua, found it impossible to get hold of a paediatrician at short notice and ended up waiting eight hours in emergency to get medical attention for her son.
Dr Dua and her tech entrepreneur husband saw a gap in the market, combining old-style home visits with new-fangled mobile technology. Patients in need of medical attention can whip out their smartphone, fire up the app, and in a few short taps have a doctor or nurse winging their way to wherever they are.
The New York-based Pager operates on the same principles, and even features an Uber-like map in its app to show users where the closest doctors are. Pager guarantees to get a doctor to wherever you are within two hours, or in the case of an emergency an immediate video hook-up with a nurse.
Then there’s 98point6 in Seattle, MedZed in Atlanta, DispatchHealth in Denver, or the New York-based FRND, which is a nurse-only callout service. Uber itself has dipped its toe in healthcare provision, piloting a flu-shot and “wellness pack” service called UberHealth.
Can this model work in Australia, with its very different healthcare and funding structures? The answer seems to be yes and no.
Home-visit apps in the style of Heal or Pager have yet to make an impact here, but after-hours services with an app component have proliferated. Examples abound, and include the likes of HomeDoctor, HouseCallDoctor, DoctorToYou, DoctorOnDuty and DoctorDoctor.
But these services are based on a business model that could yet prove flimsy. They offer bulk-billed visits, taking advantage of after-hours Medicare items that allow doctors to bill the government up to $153, if the visit is considered urgent.
Critics, including the Royal Australian College of General Practitioners, say companies may be exploiting these Medicare items, billing visits as urgent even when they’re just a case of a child with a bad cold.
There have been rumours, not denied by health minister Greg Hunt, that after-hours doctors may be targeted in the May budget, putting a serious hole in these services’ business models.
But even in the US, there are those who are not so sure that the “uberisation” of medicine is a model that actually adds up.
It comes down to the same reasons that home calls went out of fashion in the first place. They take up vastly more time – and are therefore much more expensive – than getting the patient to visit the doctor’s surgery.
A GP may get through 30 patients at her surgery, but would only be able to make seven or eight home visits, at most, in the same timeframe. At the moment, services like Heal and Pager are charging $100 to $200 per visit, but in the long term it doesn’t seem like that will sufficiently cover costs.
And yet only the wealthiest are likely to cough up the $400 to $500 that’s probably needed to make these services truly viable. That may mean that unlike Uber, which generally undercuts traditional taxi services, house call apps may end up having to appeal to a wealthy, niche audience.
One way to get around the travel factor, and another route to medicine’s Uber moment, is telemedicine. And here in Australia, there are plenty of entrepreneurs trying to make that work.
ReadyCare, for example, offers video consults with doctors at any time of the day or night for a fee of $69, and can also provide medical certificates, prescriptions and specialist referrals. GP2U, DoctorsOnDemand and Qoctor all have similar offerings, for similar prices.
None of these services is eligible for a Medicare rebate and they all have to be paid out of the patient’s pocket.
Again, these services have their critics. The Uber model is a transactional one, the critics say, whereas healthcare is about a long-term relationship between the patient and the healthcare provider.
AMA vice-president Dr Tony Bertone says that although there’s no doubt digital platforms will play an increasing role in healthcare delivery, he’s worried about the fragmentation of care they may engender.
“There’s really no replacement for an examination in person,” he says.
Resorting to video consults just because it’s the convenient option “may end up being more costly down the track, delaying the diagnosis, or even missing opportunities for preventative care”, he adds.
With Uberised medicine starting to make inroads in our own healthcare delivery system, now may be time to reframe the question from whether it’s a viable economic proposition to whether it’s actually good for patient outcomes.
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