EVALUATING TELEMEDICINE IN RURAL SETTINGS: ISSUES AND APPLICATIONS

Changes in health care policies, demographics, and technology have presented new opportunities for the delivery of medical care services and information to rural communities. Telemedicinethe use of electronic information and communications technologies to provide and support health care when distances separates the participantsis one technology that has impacted the efficiency of delivery of rural health care services. This paper presents an overview of the telemedicine technologies, government involvement in support of telemedicine, evaluation efforts to date for these technologies, and issues that need to be addressed in designing an economic-based framework to evaluate the net benefits of telemedicine technologies to rural communities and consumers. An evaluation framework needs to be capable of quantifying the tradeoffs among access to health care services, the costs of delivery of a given level of services, and changes in the quality of the service that is being delivered via electronic communications; and how these tradeoffs shift as the level of telemedicine and the technology changes. The framework that is proposed is based on models of consumer behavior that incorporate discrete choices among quality differentiated sites.rural health care, telemedicine, averted costs, economic benefits, telecommunications technology, R0, Community/Rural/Urban Development, Health Economics and Policy, I1,

EVALUATING TELEMEDICINE TECHNOLOGIES IN RURAL SETTINGS

Changes in health care policies, demographics, and technology have presented new opportunities for the delivery of medical care services and information to rural communities. Telemedicinethe use of electronic information and communications technologies to provide and support health care when distance separates the participantshas significantly impacted the delivery of rural health care services. This paper presents an overview of the telemedicine technologies, government involvement in support of telemedicine, and issues that need to be addressed in designing an economic framework to evaluate the net benefits of telemedicine to rural communities and consumers. Federal and state governments have invested millions of support dollars in the form of equipment, infrastructure, and incentives for consumers and providers to expand the use of telecommunications in medical care. Since disbursement of these funds is already underway, it only makes sense to develop a method to determine both where and whether an additional dollar of funding for telemedicine development would be of the greatest benefit to society. If telemedicine can prove itself as a useful method for improving the likelihood of survival of rural hospitals, then, in the interest of rural development, it may be a technology worth investing in; i.e., the social benefits, measured as the sum of the private and public benefits, may outweigh the costs. According to its supporters, telemedicine systems have the potential to simultaneously address several problems characteristic of health care in rural areas, including access to care, cost containment, and quality assurance. Access can be improved by linking providers in remote areas with specialists in metropolitan centers or peers in rural areas. Telemedicine not only enables a wider range of services to be offered in the local community but may have the added effect of improving physician retention in isolated areas, one of the primary challenges in maintaining access for frontier medical centers. Telemedicine can promote cost containment through the substitution of lower-cost rural providers and facilities. Ideally, improved quality will be achieved by the ready availability of consultations and referrals. These are the potential benefits of telemedicine implementation, but they have not yet been verified by research in a field setting. An evaluation framework for telemedicine needs to be capable of modeling changes in the behavior of health care consumers (i.e., altered visitation patterns), recognizing differences in quality of service, and finally, quantifying the value of these changes. This is no small task, and obtaining the required data will likely require the cooperation of many parties, including health care providers, patients, hospital and program administrators, and policymakers. These are the same groups that could benefit greatly from a better understanding of how telemedicine technologies affect health care delivery, but a meaningful framework for analysis needs to capture the many aspects of telemedicine implementation.rural health care, telemedicine, averted costs, economic benefits, telecommunications technology, R0, Community/Rural/Urban Development, Health Economics and Policy, Research and Development/Tech Change/Emerging Technologies, I1,

EVALUATING TELEMEDICINE TECHNOLOGIES IN RURAL SETTINGS

Changes in health care policies, demographics, and technology have presented new opportunities for the delivery of medical care services and information to rural communities. Telemedicine-the use of electronic information and communications technologies to provide and support health care when distance separates the participants-has significantly impacted the delivery of rural health care services. This paper presents an overview of the telemedicine technologies, government involvement in support of telemedicine, and issues that need to be addressed in designing an economic framework to evaluate the net benefits of telemedicine to rural communities and consumers. Federal and state governments have invested millions of support dollars in the form of equipment, infrastructure, and incentives for consumers and providers to expand the use of telecommunications in medical care. Since disbursement of these funds is already underway, it only makes sense to develop a method to determine both where and whether an additional dollar of funding for telemedicine development would be of the greatest benefit to society. If telemedicine can prove itself as a useful method for improving the likelihood of survival of rural hospitals, then, in the interest of rural development, it may be a technology worth investing in; i.e., the social benefits, measured as the sum of the private and public benefits, may outweigh the costs. According to its supporters, telemedicine systems have the potential to simultaneously address several problems characteristic of health care in rural areas, including access to care, cost containment, and quality assurance. Access can be improved by linking providers in remote areas with specialists in metropolitan centers or peers in rural areas. Telemedicine not only enables a wider range of services to be offered in the local community but may have the added effect of improving physician retention in isolated areas, one of the primary challenges in maintaining access for frontier medical centers. Telemedicine can promote cost containment through the substitution of lower-cost rural providers and facilities. Ideally, improved quality will be achieved by the ready availability of consultations and referrals. These are the potential benefits of telemedicine implementation, but they have not yet been verified by research in a field setting. An evaluation framework for telemedicine needs to be capable of modeling changes in the behavior of health care consumers (i.e., altered visitation patterns), recognizing differences in quality of service, and finally, quantifying the value of these changes. This is no small task, and obtaining the required data will likely require the cooperation of many parties, including health care providers, patients, hospital and program administrators, and policymakers. These are the same groups that could benefit greatly from a better understanding of how telemedicine technologies affect health care delivery, but a meaningful framework for analysis needs to capture the many aspects of telemedicine implementation

Innovations in the Delivery of Health Care Services to Rural Communities Telemedicine and Limited-Service Hospitals

Over the last decade, changes in health care policy, demographics, and technology have presented new opportunities for delivering medical care in rural areas. Telemedicine and limited-service hospitals are two innovations currently used to strengthen the likelihood of continued health care in rural communities. Montana is one of the few States where both these options have been implemented, providing a unique environment for observing the effects of each on rural health care systems, communities, and individuals

EVALUATING TELEMEDICINE IN RURAL SETTINGS: ISSUES AND APPLICATIONS

Changes in health care policies, demographics, and technology have presented new opportunities for the delivery of medical care services and information to rural communities. Telemedicine-the use of electronic information and communications technologies to provide and support health care when distances separates the participants-is one technology that has impacted the efficiency of delivery of rural health care services. This paper presents an overview of the telemedicine technologies, government involvement in support of telemedicine, evaluation efforts to date for these technologies, and issues that need to be addressed in designing an economic-based framework to evaluate the net benefits of telemedicine technologies to rural communities and consumers. An evaluation framework needs to be capable of quantifying the tradeoffs among access to health care services, the costs of delivery of a given level of services, and changes in the quality of the service that is being delivered via electronic communications; and how these tradeoffs shift as the level of telemedicine and the technology changes. The framework that is proposed is based on models of consumer behavior that incorporate discrete choices among quality differentiated sites

Farm-Level Characteristics of Southern Nebraska Farms/Ranches with Annually-Planted Crops

The information presented in this report represents data collected from farming and ranching operations in the southern two tiers of counties in Nebraska. This study was based on a random sample of 15 1 southern Nebraska farms that have annually-planted crop acreage. Information was obtained for the 1997 crop year. This data set is referred to as the MSU/UNL survey data. From the MSU/UNL survey data, the average size of the farming operations in the survey, in 1997, was 1,3 16 acres. Of these, 856 acres were planted to annual crops, and the remaining 460 acres included 61 acres in fallow, 29 acres in hay, 287 acres in range and pasture, 28 acres in CRP, and 55 acres in other uses. Operation size was largest in the west, due mostly to a large number of range and pasture land acres per operator. Average farm size decreased in the east as range and pasture land acres and acres fallowed per farm both decreased. Acreage planted to annual crops was similar from east to west. Irrigated and dryland grain corn was the predominant crop grown in the survey area. Other major crops included soybeans, sorghum, and winter wheat. An estimated 44 percent of the respondents\u27 cropland acreage was dedicated to corn production. Other annual crops included soybean (21 percent of cropland acreage), sorghum (10 percent of cropland acreage), winter wheat (12 percent of cropland acreage), and minor crops (4 percent of cropland acreage) with most of the remaining cropland in fallow. The distribution of these crops varied across the southern tier of Nebraska counties. Winter wheat was most common in the west and soybean was more prevalent in the east. About 65 percent of total cropland acreage reported was dryland while the remaining 35 percent was irrigated. Significantly more irrigation takes place in the central area. Two-thirds of the operations surveyed reported some type of livestock enterprise. Cattle were the most common type of livestock reported, followed by hogs and sheep. Breeding cattle numbers were greater than feeder cattle numbers. Dairy cattle were rarely reported except in the eastern counties. Producers in the central and eastern counties also reported hog production, with feeder hogs greatly outnumbering breeding animals. Comparisons of acres planted and crop yields from the MSU/UNL survey data to data collected by Nebraska Agricultural Statistics Service (NASS), for the same year, show little differences. Most estimates are within 2 percentage points of each other

FARM-LEVEL CHARACTERISTICS OF SOUTHERN NEBRASKA FARMS/RANCHES WITH ANNUALLY-PLANTED CROPS

The information presented in this report represents data collected from farming and ranching operations in the southern two tiers of counties in Nebraska. This study was based on a random sample of 151 southern Nebraska farms that have annually-planted crop acreage. Information was obtained for the 1997 crop year. This data set is referred to as the MSU/UNL survey data. From the MSU/UNL survey data, the average size of the farming operations in the survey, in 1997, was 1,316 acres. Of these, 856 acres were planted to annual crops, and the remaining 460 acres included 61 acres in fallow, 29 acres in hay, 287 acres in range and pasture, 28 acres in CRP, and 55 acres in other uses. Operation size was largest in the west, due mostly to a large number of range and pasture land acres per operator. Average farm size decreased in the east as range and pasture land acres and acres fallowed per farm both decreased. Acreage planted to annual crops was similar from east to west. Irrigated and dryland grain corn was the predominant crop grown in the survey area. Other major crops included soybeans, sorghum, and winter wheat. An estimated 44 percent of the respondents' cropland acreage was dedicated to corn production. Other annual crops included soybean (21 percent of cropland acreage), sorghum (10 percent of cropland acreage), winter wheat (12 percent of cropland acreage), and minor crops (4 percent of cropland acreage) with most of the remaining cropland in fallow. The distribution of these crops varied across the southern tier of Nebraska counties. Winter wheat was most common in the west and soybean was more prevalent in the east. About 65 percent of total cropland acreage reported was dryland while the remaining 35 percent was irrigated. Significantly more irrigation takes place in the central area. Two-thirds of the operations surveyed reported some type of livestock enterprise. Cattle were the most common type of livestock reported, followed by hogs and sheep. Breeding cattle numbers were greater than feeder cattle numbers. Dairy cattle were rarely reported except in the eastern counties. Producers in the central and eastern counties also reported hog production, with feeder hogs greatly outnumbering breeding animals. Comparisons of acres planted and crop yields from the MSU/UNL survey data to data collected by Nebraska Agricultural Statistics Service (NASS), for the same year, show little differences. Most estimates are within 2 percentage points of each other