E hoʻohana i ka ʻike a me nā lawelawe a NEJM Group e hoʻomākaukau ai e lilo i kauka, hōʻiliʻili ʻike, alakaʻi i kahi hui mālama olakino a hoʻoikaika i kāu hoʻomohala ʻoihana.
I ka wā maʻi maʻi Covid-19, ʻo ka hoʻomohala wikiwiki o ka telemedicine ua hoʻohuli hou i ka manaʻo hou i ka hoʻopaʻapaʻa e pili ana i ka laikini kauka.Ma mua o ka maʻi maʻi maʻi, hoʻopuka pinepine nā mokuʻāina i nā laikini no nā kauka e pili ana i ke kulekele i hōʻike ʻia ma kēlā me kēia mokuʻāina ʻo Medical Practice Act, kahi i ʻōlelo ʻia e pono e laikini ʻia nā kauka ma ka mokuʻāina kahi i loaʻa ai ka mea maʻi.No nā kauka e makemake ana e hoʻohana i ka telemedicine e mālama i nā maʻi ma waho o ka mokuʻāina, hana kēia koi i nā pilikia hoʻokele nui a me ke kālā no lākou.
I ka hoʻomaka mua ʻana o ka maʻi maʻi, ua hoʻopau ʻia nā pilikia pili i ka laikini.Ua hoʻopuka nā mokuʻāina he nui i nā ʻōlelo manawaleʻa e ʻike i nā laikini lapaʻau o waho.1 Ma ka pae federal, ua hoʻokuʻu aku ʻo Medicare a me Medicaid Services i nā koi a Medicare no ka loaʻa ʻana o ka laikini kauka ma ka mokuʻāina o ka mea maʻi.2 Ua hiki i kēia mau hoʻololi pōkole ke mālama i nā mea maʻi i loaʻa ma o telemedicine i ka wā maʻi Covid-19.
Ke manaʻoʻiʻo nei kekahi mau kauka, loea, a me nā mea hana kulekele ʻo ka hoʻomohala ʻana i ka telemedicine he ʻulaʻula o ka manaolana no ka maʻi maʻi, a ke noʻonoʻo nei ʻo Congress i nā bila he nui e hāpai i ka hoʻohana ʻana i ka telemedicine.Manaʻo mākou ʻo ka hoʻoponopono ʻana i ka laikini ke kī nui i ka hoʻonui ʻana i ka hoʻohana ʻana i kēia mau lawelawe.
ʻOiai ua mālama nā moku'āina i ka pono e hoʻomaʻamaʻa i nā laikini lapaʻau mai ka hopena o 1800s, ʻo ka hoʻomohala ʻana o nā ʻōnaehana olakino ākea ākea a me nā ʻōnaehana olakino a me ka hoʻonui ʻana i ka hoʻohana ʻana i ka telemedicine ua hoʻonui i ka nui o ka mākeke mālama ola ma mua o nā palena ʻāina.I kekahi manawa, ʻaʻole kūlike nā ʻōnaehana mokuʻāina i ka manaʻo maʻamau.Ua lohe mākou i nā moʻolelo e pili ana i nā poʻe maʻi i hoʻokele i nā mile ma ka laina mokuʻāina e komo i nā kipa telemedicine mālama mua mai kā lākou kaʻa.ʻAʻole hiki i kēia mau maʻi ke komo i ka manawa like ma ka home no ka mea ʻaʻole laikini kā lākou kauka ma kahi o ka noho ʻana.
No ka manawa lōʻihi, ua hopohopo ka poʻe no ka nānā nui ʻana o ke Komisina Laikini Moku'āina i ka pale ʻana i kona mau lālā mai ka hoʻokūkū, ma mua o ka lawelawe ʻana i ka pono o ka lehulehu.I ka makahiki 2014, ua hoʻopiʻi maikaʻi ka Federal Trade Commission i ka North Carolina Board of Dental Inspectors, me ka hoʻopaʻapaʻa ʻana i ka pāpā ʻole ʻana o ke Komisina i ka poʻe ʻaʻole niho niho mai ka hoʻolako ʻana i nā lawelawe keʻokeʻo i uhaki i nā kānāwai antitrust.Ma hope mai, ua hoʻopiʻi ʻia kēia hihia o ka ʻAha Kiʻi ma Texas e kūʻē i nā lula laikini e kaupalena ana i ka hoʻohana ʻana i ka telemedicine ma ka mokuʻāina.
Eia hou, hāʻawi ke Kumukānāwai i ka mea nui i ke aupuni pekelala, e pili ana i nā kānāwai mokuʻāina e hoʻopilikia ana i ke kālepa waena.Ua hana ʻo Congress i kekahi mau ʻokoʻa no ka mokuʻāina?Ka mana kūʻokoʻa i laikini ʻia, ʻoi aku hoʻi i nā papahana olakino federal.No ka laʻana, koi ka VA Mission Act o 2018 i nā mokuʻāina e ʻae i nā kauka o waho o ka mokuʻāina e hoʻomaʻamaʻa telemedicine i loko o ka ʻōnaehana Veterans Affairs (VA).ʻO ka hoʻomohala ʻana o ka telemedicine interstate e hāʻawi i kahi manawa hou no ke aupuni federal e komo.
Ma kahi o ʻehā mau ʻano hoʻoponopono i hāpai ʻia a hoʻolauna ʻia e hoʻolaha i ka telemedicine interstate.Hoʻokumu ʻia ke ʻano hana mua ma luna o ka ʻōnaehana ʻae lapaʻau e pili ana i ka mokuʻāina i kēia manawa, akā e maʻalahi i nā kauka ke loaʻa nā palapala ʻae i waho o ka mokuʻāina.Ua hoʻokō ʻia ka ʻaelike laikini lapaʻau ma waena o ka mokuʻāina ma 2017. He kuʻikahi like ia ma waena o 28 states a me Guam e wikiwiki i ka hana kuʻuna o nā kauka i loaʻa nā laikini mokuʻāina kuʻuna (e ʻike i ka palapala ʻāina).Ma hope o ka uku ʻana i ka uku franchise $700, hiki i nā kauka ke loaʻa nā laikini mai nā ʻāina ʻē aʻe e komo ana, me nā uku mai $75 ma Alabama a i ʻole Wisconsin a $790 ma Maryland.Ma Malaki 2020, ʻo 2,591 wale nō (0.4%) o nā kauka i nā mokuʻāina i komo i hoʻohana i ka ʻaelike e loaʻa ai kahi laikini ma kekahi mokuʻāina.Hiki i ka ʻaha'ōlelo ke hoʻoholo i nā kānāwai e paipai i nā mokuʻāina i koe e komo i ka ʻaelike.ʻOiai he haʻahaʻa ka hoʻohana ʻana o ka ʻōnaehana, hoʻonui i ka ʻaelike i nā mokuʻāina āpau, e hōʻemi ana i nā kumukūʻai a me nā kaumaha hoʻokele, a ʻoi aku ka maikaʻi o ka hoʻolaha ʻana e alakaʻi i ke komo nui ʻana.
ʻO kahi koho kulekele ʻē aʻe e paipai i ka pānaʻi, ma lalo o nā mokuʻāina e ʻike ʻokoʻa i nā laikini waho o ka mokuʻāina.Ua ʻae ʻo Congress i nā kauka e hoʻomaʻamaʻa ana i ka ʻōnaehana VA e loaʻa nā pōmaikaʻi like ʻole, a i ka wā o ka maʻi maʻi, ua hoʻokō ka hapa nui o nā mokuʻāina i nā kulekele pānaʻi.I ka makahiki 2013, ua hāpai ke kānāwai pekelala i ka hoʻokō mau ʻana o ka pānaʻi like ʻole i ka papahana Medicare.3
ʻO ke kolu o ke ʻano o ka hoʻomaʻamaʻa ʻana i ka lāʻau lapaʻau e pili ana i kahi o ke kauka ma mua o kahi o ka mea maʻi.Wahi a ka National Defence Authorization Act o 2012, pono e laikini ʻia nā kauka nāna e mālama ma lalo o TriCare (Military Health Program) ma ka mokuʻāina kahi i noho maoli ai lākou, a ʻae kēia kulekele i ka hana lapaʻau interstate.Ua hoʻolauna ʻo Senators Ted Cruz (R-TX) a me Martha Blackburn (R-TN) i ka "Equal Access to Medical Services Act", kahi e hoʻopili ai i kēia kumu hoʻohālike i nā hana telemedicine ma ka ʻāina.
Ka hoʻolālā hope -?A ʻo ka manaʻo kikoʻī loa ma waena o nā manaʻo i kūkākūkā maikaʻi ʻia - e hoʻokō ʻia ka laikini hoʻomaʻamaʻa federal.I ka makahiki 2012, ua noi ʻo Senatoa Tom Udall (D-NM) (akā ʻaʻole i hoʻokomo mua ʻia) i bila e hoʻokumu i kahi kaʻina hana laikini serial.Ma kēia kumu hoʻohālike, pono nā kauka lapaʻau makemake i ka hana ma waena o ka mokuʻāina no ka laikini mokuʻāina me ka laikini mokuʻāina4.
ʻOiai he manaʻo maikaʻi ka noʻonoʻo ʻana i kahi laikini federal hoʻokahi, ʻaʻole kūpono paha ia kulekele no ka mea e nānā ʻole i ka ʻike o ka ʻoi aku o hoʻokahi haneli o nā ʻōnaehana laikini mokuʻāina.He kuleana koʻikoʻi ko ke kōmike ma nā hana hoʻopaʻi, e hana ana i nā kaukani kaukani i kēlā me kēia makahiki.5 ʻO ka hoʻololi ʻana i ka ʻōnaehana laikini federal e hōʻemi paha i nā mana hoʻopaʻi aupuni.Eia kekahi, ʻo nā kauka a me nā papa lāʻau lapaʻau mokuʻāina e hāʻawi mua ana i ka mālama maka-a-maka he kuleana koʻikoʻi i ka mālama ʻana i kahi ʻōnaehana laikini mokuʻāina e hoʻopaʻa i ka hoʻokūkū mai nā mea hoʻolako o waho, a e hoʻāʻo paha lākou e hoʻohaʻahaʻa i ia mau hoʻoponopono.ʻO ka hāʻawi ʻana i nā laikini mālama lapaʻau e pili ana i ka wahi o ke kauka he hopena akamai, akā hoʻopiʻi pū kekahi i ka ʻōnaehana lōʻihi e hoʻoponopono i ka hana lapaʻau.ʻO ka hoʻololi ʻana i ka hoʻolālā e pili ana i ka wahi e lilo paha i mau pilikia no ka papa?Nā hana hoʻopaʻi a me ka laulā.Mahalo i nā hoʻoponopono aupuni No laila, ʻo ka hoʻomalu mōʻaukala o nā ʻae ke ala maikaʻi loa i mua.
I ka manawa like, ʻike ʻia kahi hoʻolālā kūpono ʻole e manaʻo e hana nā mokuʻāina i kā lākou hana ponoʻī e hoʻonui i nā koho no ka laikini waho.Ma waena o nā kauka i nā ʻāina e komo nei, ua haʻahaʻa ka hoʻohana ʻana i nā kuʻikahi interstate, e hōʻike ana i ka hiki ke hoʻomau i nā pale hoʻokele a me ke kālā e pale i ka telemedicine interstate.Ma ka noʻonoʻo ʻana i ke kūʻē kūʻokoʻa, ʻaʻole paha e hana nā mokuʻāina i nā kānāwai pānaʻi paʻa ma o lākou iho.
Malia paha ʻo ka hoʻolālā ʻoi loa ka hoʻohana ʻana i nā mana federal e paipai i ka pānaʻi.Hiki i ka ʻaha'ōlelo ke koi aku i ka ʻae no ka pānaʻi ʻana i loko o ka pōʻaiapili o kahi papahana federal ʻē aʻe, ʻo Medicare, ma muli o ke kānāwai mua e hoʻoponopono ana i nā kauka ma ka ʻōnaehana VA a me TriCare.Inā loaʻa iā lākou kahi laikini lapaʻau kūpono, hiki iā lākou ke ʻae i nā kauka e hāʻawi i nā lawelawe telemedicine i nā mea kōkua Medicare ma kekahi mokuʻāina.ʻO ia ʻano kulekele e hoʻolōʻihi i ka hoʻoholo ʻana i nā kānāwai aupuni e pili ana i ka pānaʻi, e pili pū ana i nā maʻi e hoʻohana ana i nā ʻano ʻinikua ʻē aʻe.
Ua hoʻāla ka maʻi maʻi Covid-19 i nā nīnau e pili ana i ka pono o ka papa hana laikini e kū nei, a ua lilo i mea maopopo loa i nā ʻōnaehana e hilinaʻi ana i ka telemedicine e kūpono i kahi ʻōnaehana hou.Nui nā kumu hoʻohālike kūpono, a ʻo ke kiʻekiʻe o ka hoʻololi ʻana mai ka hoʻonui a hiki i ka hoʻonohonoho.Manaʻo mākou ʻo ka hoʻokumu ʻana i ka ʻōnaehana laikini aupuni e kū nei, akā ʻo ka hoʻoikaika ʻana i ka launa pū ʻana ma waena o nā ʻāina ʻo ia ke ala ʻoiaʻiʻo loa i mua.
Mai ke Kula Lapaʻau ʻo Harvard a me Beth Israel Deaconess Medical Center (AM), a me Tufts University School of Medicine (AN) -?Aia lāua ma Bosetona;a me Duke University School of Law (BR) ma Durham, North Carolina.
1. Ka Hui o na Aha Lapaau Lahui.Ua hoʻoponopono hou nā mokuʻāina a me nā panalāʻau o US i nā koi laikini kauka ma muli o COVID-19.Pepeluali 1, 2021 (https://www.fsmb.org/siteassets/advocacy/pdf/state-emergency-declarations-licensures-requirementscovid-19.pdf).
2. Inikua lapaʻau a me ke kikowaena lawelawe kōkua kino.Hoʻokuʻu ʻia ka uhi ʻōlelo hoʻolaha pilikia COVID-19 no nā mea mālama olakino.Kekemapa 1, 2020 (https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf).
3. Ka 2013 TELE-MED Act, HR 3077, Satoshi 113. (2013-2014) (https://www.congress.gov/bill/113th-congress/house-bill/3077).
4. Ua hana hou nā kākoʻo o Norman J. Telemedicine no ka hana laikini kauka ma nā palena mokuʻāina.New York: Federal Fund, Ianuali 31, 2012 (https://www.commonwealthfund.org/publications/newsletter-article/telemedicine-supporters-launch-new-effort-doctor-licensing-across).
5. ʻO ka Hui o nā ʻAha Lapaʻau Lapaʻau.Nā Hana Hoʻoponopono Lapaʻau US, 2018. Kekemapa 3, 2018 (https://www.fsmb.org/siteassets/advocacy/publications/us-medical-regulatory-trends-actions.pdf).
Ka manawa hoʻouna: Mar-01-2021