covid 19使远程医疗更加普及，这使我们的生活更加美好-优快云博客

新冠疫情推动远程医疗服务在美国迅速普及，不仅降低了就医成本，提高了患者满意度，还为慢性病患者提供了便利。随着政策的支持，远程医疗有望成为医疗系统的重要组成部分。

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Before the arrival of the novel coronavirus, telemedicine — allowing patients to have contact with a health care provider over a web interface or via a phone call instead of through a face-to-face appointment — was not widely used. Insurers and government health programs severely limited the circumstances in which they would pay for a virtual visit, and relatively few providers had figured out the logistics of offering telemedicine.

在新型冠状病毒到来之前，远程医疗尚未得到广泛使用，该技术允许患者通过Web界面或通过电话而不是通过面对面的预约与医疗保健提供者进行联系。保险公司和政府的医疗计划严重限制了他们为虚拟访问付费的环境，而且相对很少的提供者已经知道提供远程医疗的后勤保障。

That changed abruptly when the risk of contracting COVID-19 caused people to avoid as many in-person interactions as possible, including trips to the doctor, therapist or other health care provider. Almost immediately, the federal government and private insurers expanded their coverage, providers adjusted their practices, and patients began using telemedicine.

当感染COVID-19的风险导致人们避免尽可能多的面对面互动时，包括去看医生，治疗师或其他医疗服务提供者时，这种情况突然改变了。几乎立即，联邦政府和私人保险公司扩大了覆盖范围，提供者调整了做法，患者开始使用远程医疗。

Though we all eagerly await the day when it is safe to have dinner with friends, send our kids to school and grocery shop without a mask, we don’t necessarily want to return to a world in which every interaction with a health care provider has to be in person. The nation’s health care system will work better for patients by maintaining the expanded access to telemedicine forced upon us by the coronavirus.

尽管我们都热切期待与朋友共进晚餐的日子，不带口罩送我们的孩子去学校和杂货店，但我们不一定要回到一个与医疗保健提供者进行每次互动的世界亲自面对。通过维持冠状病毒对我们施加的远程医疗服务的扩展访问，美国的医疗体系将更好地为患者服务。

Telemedicine visits have increased dramatically since the start of the pandemic. For example, before the pandemic, 13,000 Medicare recipients received care through a telemedicine visit each week. That had grown to 1.7 million Medicare patients by the last week of April. Telemedicine visits were especially common for routine matters that might have been covered in an office visit and for mental health issues. More than one-third of Medicare beneficiaries who had an “office visit” did so via telemedicine, and 60 percent of behavioral health visits were virtual.

自大流行开始以来，远程医疗就诊人数急剧增加。例如，在大流行之前，每周有13,000名Medicare接受者通过远程医疗就诊。到四月的最后一周，这一数字已增长到170万名 Medicare患者。远程医疗就诊对于办公室诊治中可能涉及的日常事务和精神健康问题尤其普遍。进行了“办公室就诊”的医疗保险受益人中，超过三分之一是通过远程医疗进行的，而60％的行为健康就诊是虚拟的。

Medicare data shows that patients from a variety of backgrounds have embraced telemedicine. 30 percent of urban Medicare patients used telemedicine, compared to 22 percent of rural beneficiaries. Men and women had telemedicine appointments at nearly the same rate. Age didn’t affect use: Of patients ages 65–74, 25 percent used telemedicine, while 29 percent of beneficiaries ages 75–84 did. Telemedicine use didn’t vary significantly by race or ethnic group, either. And low-income patients who qualify for Medicaid in addition to Medicare used telemedicine at a higher rate than Medicare-only patients.

Medicare数据显示，来自不同背景的患者都接受了远程医疗。 30％的城市Medicare患者使用远程医疗，而农村受益者为22％。男性和女性的远程医疗预约率几乎相同。年龄不影响使用：65-74岁的患者中，有25％的人使用了远程医疗，而75-84岁的受益人中有29％了。远程医疗的使用也不因种族或种族而有显着差异。除Medicare之外，还有资格获得Medicaid的低收入患者使用远程医疗的比例要高于仅Medicare的患者。

Patients are willing to use telemedicine at such high rates because it delivers multiple benefits. It can provide easier access to care — no need to drive or ride transit to the provider’s office, or to arrange for child care during that time. If the patient is employed, a telemedicine visit requires less time off from work than an in-person visit would. Removing these logistical barriers can make it easier for patients to receive care, especially for recurring appointments. For example, the no-show rate of patients receiving addiction counseling at one community health center in Northern California fell from 60 percent pre-pandemic to just 11 percent.

患者愿意以如此高的比率使用远程医疗，因为它具有多种好处。它可以提供更容易的护理服务 -无需开车或乘搭公交车前往提供者的办公室，也无需在此期间安排托儿服务。如果雇用患者，则远程医疗就诊所需的时间要比面对面拜访少。消除这些后勤障碍可以使患者更容易接受护理，尤其是对于定期约会。例如，在北加利福尼亚州的一个社区卫生中心接受戒毒咨询的患者的缺席率从大流行前的60％降至仅11％。

Telemedicine has its limitations, of course. Some types of medical care have to be provided in person, such as when a hands-on exam is needed or a patient needs to have their blood pressure checked. Another challenge of telemedicine is that not all patients may be able to access virtual services. Some patients, especially in rural areas, may not have broadband access that can support a video appointment. Others may not have a computer or a phone with a data plan, or may lack the technical skills to feel comfortable with an online appointment. In other cases, the hurdles may not be technological. In crowded housing situations, a patient may not be able to find a sufficiently private location to feel comfortable participating in a telemedicine visit with their doctor. For these and other reasons, telemedicine visits should be available to, but not required of, patients.

当然，远程医疗有其局限性。某些类型的医疗服务必须亲自提供，例如当需要动手检查或患者需要检查血压时。远程医疗的另一个挑战是，并非所有患者都可以访问虚拟服务。一些患者，特别是在农村地区的患者，可能没有宽带接入可以支持视频约会。其他人可能没有配备数据计划的计算机或电话，或者可能缺乏满足在线约会需求的技术技能。在其他情况下，障碍可能不是技术上的。在住房拥挤的情况下，患者可能无法找到足够私密的位置，无法与医生一起参加远程医疗访问。由于这些及其他原因，患者应该可以进行远程医疗就诊，但不是必须的。

Overall, though, both patients and providers have responded favorably to the increased use of telemedicine. According to McKinsey, nearly three-quarters of patients who have had a telemedicine visit report being highly satisfied. More than 75 percent of people surveyed said they were likely to use telemedicine in the future. A majority of providers now have a more favorable view of telemedicine, and two-thirds report that they have grown more comfortable with virtual visits.

总体而言，尽管如此，患者和医疗服务提供者对远程医疗使用的增加均React良好。麦肯锡公司表示，近四分之三的远程医疗就诊患者对此感到非常满意。超过75％的受访者表示，他们将来可能会使用远程医疗。现在，大多数提供者对远程医疗抱有更乐观的看法，三分之二的人报告说他们对虚拟访问越来越满意。

For the health care system overall, increased use of telemedicine has the potential to reduce costs. An estimated 20 percent of emergency department visits — those for more minor concerns — could be replaced with telemedicine. On an ongoing basis, care for patients with chronic conditions that require regular check-ups may be less expensive if some care is conducted via virtual visits rather than in-person appointments. However, policymakers will need to guard against potential abuses by providers or insurers that could increase costs for patients, such as higher fees for telemedicine visits than in-person visits.

对于整个卫生保健系统，增加远程医疗的使用可能会降低成本。估计有20％的急诊就诊-那些次要问题-可以用远程医疗代替。在持续的基础上，如果需要通过虚拟拜访而非亲自预约进行某些护理，则对需要定期检查的慢性病患者的护理费用可能会更低。但是，政策制定者将需要防范提供者或保险公司的潜在滥用行为，这些滥用行为可能会增加患者的费用，例如远程医疗就诊的费用要比面对面就诊的费用高。

Both the federal government and states appear to be ready to facilitate the continued use and expansion of telemedicine. The idea has bipartisan support, with the left-leaning Public Policy Institute and the conservative group Americans for Prosperity jointly releasing a set of recommendations for how to permanently increase access to telemedicine.

联邦政府和各州似乎都准备好促进远程医疗的持续使用和扩展。这个想法得到了两党的支持，左倾的公共政策研究所和保守派组织“美国人繁荣” 联合发布了一系列有关如何永久增加远程医疗访问的建议。

In early August, President Trump signed an executive order to permanently approve broader access to telemedicine visits for rural Medicare patients. Ensuring continued access to telemedicine for all Medicare enrollees, however, will require congressional action. One congressional analyst expects Congress to act by the end of the year.

8月初，特朗普总统签署了一项行政命令，以永久批准农村医疗保险患者获得远程医疗就诊的广泛机会。但是，要确保所有Medicare参与者都能继续使用远程医疗，将需要国会采取行动。一位国会分析师预计国会将在今年年底之前采取行动。

States will also need to extend provisions that have allowed Medicaid patients greater access to virtual health care services. Such policies include eased licensing requirements for out-of-state doctors, allowing them to provide telemedicine services across state lines; making telemedicine available to patients who don’t live in rural areas; and including phone calls, not just video calls, in their definition of covered telemedicine services.

州也将需要扩展条款，使医疗补助患者能够更好地使用虚拟医疗服务。这些政策包括放宽对州外医生的许可要求，使他们能够跨州提供远程医疗服务；为非农村地区的患者提供远程医疗；在涵盖的远程医疗服务的定义中包括电话呼叫，而不仅仅是视频电话。

While providers may invest in technologies to make virtual visits easier and private insurers may revise their policies to promote the use of telemedicine, policymakers can also ensure this happens. Proposed legislation in Massachusetts, for example, would require insurers to pay for telemedicine visits for primary care, chronic disease management and behavioral health.

提供者可能会投资技术以简化虚拟访问，而私人保险公司可能会修改其政策以促进远程医疗的使用，而政策制定者也可以确保这种情况发生。例如，马萨诸塞州的拟议立法将要求保险公司为基本医疗保健，慢性病管理和行为健康支付远程医疗费用。

The coronavirus pandemic has forced Americans to substitute virtual interactions for many things we’d rather do in-person. Though we’ll eagerly return to classrooms or meals with friends, we’ll be happy to have the option of skipping the long wait at the doctor’s office. Expanded access to telemedicine is one change precipitated by the coronavirus pandemic that has changed our health care system for the better.

冠状病毒大流行迫使美国人用虚拟互动代替了我们宁愿亲自做的许多事情。尽管我们会急于返回教室或与朋友聚餐，但我们很乐意选择跳过在医生办公室的漫长等待。冠状病毒大流行引发的变化是扩大获得远程医疗的机会，这种变化使我们的医疗保健系统变得更好。

Originally published at https://frontiergroup.org on September 9, 2020.

最初于 2020年9月9日 在 https://frontiergroup.org 上发布。