mHealth, eHealth Economics: What do we need to know

In a recent research article in the Journal of Health Communication, researchers assessed key eHealth economic and financial questions that countries should ask as they decide how much to invest in eHealth technologies.
The researchers used a definition of eHealth which included mHealth technology.
The authors of the article indicated that despite the potential (think hype), little evidence currently exists to help countries decide if eHealth technologies can provide substantial savings to health care systems.
As with other health technologies, claiming health care savings and proving savings are two completely different things with the latter being much more difficult.
So, according to the researchers, what more must our and other countries know, or at least research, as we continue investing substantial amounts of money into eHealth?

The researchers identified three major areas of concern:

• the costs of eHealth
• the benefits of ehealth
• regulatory infrastructure

What’s not so clear is how the researchers picked these three areas. There was no systematic analysis of existing eHealth economic information, or any other discernible method to their approach, leaving the door open for better assessments of existing economic information.
Nevertheless, here are the key issues they raised for each of these major areas.

Costs of eHealth

With regard to costs, the researchers discussed the impact of eHealth on health care costs generally. They indicated that there is currently not a good course of data on eHealth costs so that costs of non-health care technology (such as iPads being used in hospitals) could be used as an immediate proxy for eHealth costs. The desire of innovators in the field is that eHealth reduce health care costs overall, but without data this is only a hope.
Proxy data can help demonstrate if costs are going up or down. Thus, all the mobile devices and their related plans floating around in the pockets of patients and practitioners in various health care organizations worldwide could be viewed as health care costs. This seems to work best for devices that are dedicated to a health care role versus those which are used for calling home and calling patients. Another method of examining eHealth costs is to measure health services used as a result of mHealth – such as remote monitoring by doctors leading to them doing more work in rural areas despite their urban location. Their services are not free so they generate health care costs for the rural area which may not have existed otherwise.
Next, the authors discussed the drivers of eHealth costs. They stated that infrastructure was a key driver of costs and that efforts should be made to decrease these costs. One counterargument to this notion is that the infrastructure – such as wireless Internet connections may already exist for other purposes and health care use of the infrastructure may not pose any new financial burden. For example, if patients are able to provide information to a physician using data on their mobile phone instead of filling out paper, they could simply use any existing infrastructure they purchase to provide the information. The infrastructure does not incur a new cost.
The researchers also discussed the upfront investment required to develop eHealth infrastructure. This applies more to wired technologies than wireless, satellite based technologies. In addition, if health care institutions relied on cloud technologies instead of attempting to house their own data, they could cut infrastructure costs substantially. In fact, the authors admit that the “costs of wireless hardware and services are generally shared with non-health services, resulting in potential cost savings.” Another driver was the task shifting of health care workers from their normal tasks to any new tasks required by eHealth technologies – such as keeping up with 24 hour monitors that report data on their patient populations.
This is a key driver which health care organizations should consider creative ways to manage. Appropriate reimbursement of health care workers engaged in eHealth care practice will be a key issue for the economics of eHealth.
The third costs concern was public/private partnerships that are leading to the development of eHealth technologies. The researchers state that the disjointed funding mechanisms of eHealth may lead to various technologies that lack interoperability. The counter to this argument is that the systems may lead to more competitive offerings by the private sectors.
Just like Mac and PC customers, health care organizations will need to decide whether interoperability is more important for these technologies than innovative approaches. Innovation which leads to confusion and poor interaction between systems is likely to be less useful than innovation which builds on prior platforms and allows organizations to update their eHealth technologies in a more seamless fashion. For this issue, the researchers identified a couple of key research questions:

• What reforms are needed to incentivize investment in, and use of, eHealth services and devices?
• What incentives can the public sector put in place to drive down costs?”

eHealth Benefits / Regulatory Structure

In their discussion of eHealth benefits, the researchers noted that:

• data on benefits can be used to attract more public and private investment dollars
• measurement of benefits was necessary to determine the cost effectiveness of eHealth investment
• analyses of eHealth benefits should focus on clinical and social outcomes using reliable factors that can be measured

In general, their thoughts on benefits were fairly straightforward. The challenge appears to be implementing eHealth interventions that actually create these benefits – something which other health care technology industries also struggle with.
As prior authors have noted, the researchers support modifying regulatory structures to incentivize the creation of eHealth technologies that are beneficial. This would focus mainly on incentivizing the creation of these technologies in different health care settings. This is particularly important in low and middle income countries.

What’s still missing?

The researchers clearly stated that a sound investment case for eHealth requires a targeted research program across a diverse group of countries – of different income levels. The threshold for investment appears to be lower in developed countries based on their view, but lower and middle income countries need more evidence before they invest their limited funds in such ventures.
With regards to understanding more about the economics of eHealth, a systematic analysis of existing economic analyses on eHealth technologies is needed. The researchers of this study provide some key questions to consider, but don’t indicate which questions have already been addressed by scholars who are either directly evaluating the economic implications of eHealth technologies or assessing the economics of the use of these technologies in other fields which can by proxy provide clues to the economics of eHealth.
A review of this nature and more studies addressing the questions the researchers posed would be useful for creating a better understanding of eHealth economics.