Economic modelling of telehealth substitution of face-to-face specialist outpatient consultations for Queensland correctional facilities
Monica Taylor A , Liam J. Caffery A , Paul A. Scuffham B and Anthony C. Smith A CA Centre for Online Health, The University of Queensland, Ground Floor, Building 33, Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia. Email: m.taylor2@uq.edu.au; l.caffery@uq.edu.au
B Centre for Applied Health Economics, Griffith University, 170 Kessels Road, Nathan, Qld 4111, Australia. Email: p.scuffham@griffith.edu.au
C Corresponding author. Email: asmith@uq.edu.au
Australian Health Review 42(5) 522-528 https://doi.org/10.1071/AH17135
Submitted: 5 June 2017 Accepted: 4 October 2017 Published: 28 November 2017
Abstract
Objective The provision of healthcare services to inmates in correctional facilities is costly and resource-intensive. This study aimed to estimate the costs of transporting prisoners from 11 Queensland correctional facilities to the Princess Alexandra Hospital Secure Unit (PAHSU) in Brisbane for non-urgent specialist outpatient consultations and identify the cost consequences that would result from the substitution of face-to-face visits with telehealth consultations.
Methods A 12-month retrospective review of patient activity at the PAHSU was conducted to obtain the number of transfers per correctional facility. The total cost of transfers was calculated with estimates for transport vehicle costs and correctional staff escort wages, per diem and accommodation costs. A cost model was developed to estimate the potential cost savings from substituting face-to-face consultations with telehealth consultations. A sensitivity analysis on the cost variables was conducted. Costs are reported from a government funding perspective and presented in 2016 Australian dollars (A$).
Results There were 3539 inmate appointments from July 2015 to June 2016 at the PAHSU, primarily for imaging, general practice, and orthopaedics. Telehealth may result in cost savings from negligible to A$969 731, depending on the proportion, and travel distance, of face-to-face consultations substituted by telehealth. Wages of correctional staff were found to be the most sensitive variable.
Conclusions Under the modelled conditions, telehealth may reduce the cost of providing specialist outpatient consultations to prisoners in Queensland correctional facilities. Telehealth may improve the timeliness of services to a traditionally underserved population.
What is known about the topic? Specialist medical services are located in only a few metropolitan centres across Australia, which requires some populations to travel long distances to attend appointments. Some face-to-face specialist outpatient consultations can be substituted by telehealth.
What does this paper add? Prisoners from correctional facilities represent one specific population that requires complex travel arrangements for specialist medical appointments. Transportation of prisoners for specialist health appointments represents a substantial cost to the government. This paper quantifies the annual cost in Queensland for transporting prisoners, taking into account fuel and vehicle costs, staff wages, per diem rates, and accommodation. In addition, it quantifies the costs of substituting face-to-face consultations with telehealth consultations.
What are the implications for practitioners? This research encourages practitioners to consider using telehealth services for prisoners, as well providing an argument for tertiary centres to include telehealth as a model of care for this population. Telehealth can result in major cost savings and state and federal governments should consider implementation especially in Australia where correctional facilities and specialist services are separated by great geographic distances.
References
[1] Australian Institute of Health and Welfare (AIHW). Prisoner health services in Australia 2012. Bulletin no.123. Canberra: AIHW; 2014.[2] Australian Institute of Health and Welfare (AIHW). The health of Australia’s prisoners 2012. Canberra: AIHW; 2013.
[3] Australian Bureau of Statistics (ABS). Prisoners in Australia 2014. Canberra: ABS; 2014. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4517.0Main+Features12014?OpenDocument [verified 27 October 2017].
[4] Australian Institute of Health and Welfare (AIHW). The health of Australia’s prisoners 2015. Canberra: Australian Government; 2015. Available at: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129553682 [verified 29 September 2016].
[5] Brecht RM, Gray CL, Peterson C, Youngblood B. The University of Texas Medical Branch–Texas Department of Criminal Justice Telemedicine Project: findings from the first year of operation. Telemed J 1996; 2 25–35.
| The University of Texas Medical Branch–Texas Department of Criminal Justice Telemedicine Project: findings from the first year of operation.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s3gvVKguw%3D%3D&md5=6d2bf83defc24fff5e80579ec6a7c4bbCAS |
[6] Brunicardi BO. Financial analysis of savings from telemedicine in Ohio’s prison system. Telemed J 1998; 4 49–54.
| Financial analysis of savings from telemedicine in Ohio’s prison system.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c3isVCitA%3D%3D&md5=c0489d9d5af13c70ab11f70ce46435a7CAS |
[7] McCue MJ, Hampton CL, Malloy W, Fisk KJ, Dixon L, Neece A. Financial analysis of telecardiology used in a correctional setting. Telemed J E Health 2000; 6 385–91.
| Financial analysis of telecardiology used in a correctional setting.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7msVCitg%3D%3D&md5=15f7faf465cee9e74f41b5a1eab5c590CAS |
[8] McCue MJ, Mazmanian PE, Hampton C, Marks TK, Fisher E, Parpart F, Krick RS. The case of Powhatan correctional center/Virginia department of corrections and Virginia commonwealth university/Medical college of Virginia. Telemed J 1997; 3 11–7.
| The case of Powhatan correctional center/Virginia department of corrections and Virginia commonwealth university/Medical college of Virginia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s3mslCltQ%3D%3D&md5=6b1c78a36bbd163061f34c3fa05ba58bCAS |
[9] McCue MJ, Mazmanian PE, Hampton CL, Marks TK, Fisher EJ, Parpart F, Malloy WN, Fisk KJ. Cost-minimization analysis: a follow-up study of a telemedicine program. Telemed J 1998; 4 323–7.
| Cost-minimization analysis: a follow-up study of a telemedicine program.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M3jvVGnsg%3D%3D&md5=757b3ca0515e636705a7a60ca0d8df29CAS |
[10] Zincone LH, Doty E, Balch DC. Financial analysis of telemedicine in a prison system. Telemed J 1997; 3 247–55.
| Financial analysis of telemedicine in a prison system.Crossref | GoogleScholarGoogle Scholar |
[11] Deslich SA, Thistlethwaite T, Coustasse A. Telepsychiatry in correctional facilities: using technology to improve access and decrease costs of mental health care in underserved populations. Perm J 2013; 17 80–6.
| Telepsychiatry in correctional facilities: using technology to improve access and decrease costs of mental health care in underserved populations.Crossref | GoogleScholarGoogle Scholar |
[12] Glaser M, Winchell T, Plant P, Wilbright W, Kaiser M, Butler MK, Goldshore M, Magnus M. Provider satisfaction and patient outcomes associated with a statewide prison telemedicine program in Louisiana. Telemed J E Health 2010; 16 472–9.
| Provider satisfaction and patient outcomes associated with a statewide prison telemedicine program in Louisiana.Crossref | GoogleScholarGoogle Scholar |
[13] Mekhjian H, Turner JW, Gailiun M, McCain TA. Patient satisfaction with telemedicine in a prison environment. J Telemed Telecare 1999; 5 55–61.
| Patient satisfaction with telemedicine in a prison environment.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1MvjsV2qtw%3D%3D&md5=17c91e8d0832e583cbccff291c223011CAS |
[14] Mekhjian H, Warisse J, Gailiun M, McCain T. An Ohio telemedicine system for prison inmates: a case report. Telemed J 1996; 2 17–24.
| An Ohio telemedicine system for prison inmates: a case report.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s3gvVKgug%3D%3D&md5=e61582f0319ddd4023a7bead93bcb3a9CAS |
[15] Australian Bureau of Statistics (ABS). Corrective services, Australia, June Quarter 2016. Canberra: ABS; Australia; 2016. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4512.0 [verified 29 September 2016].
[16] Australian Institute of Criminology. Queensland correctional facilities. Canberra: Australian Government; 2016. Available at: http://www.aic.gov.au/criminal_justice_system/corrections/facilities/qld.html [verified 29 September 2016].
[17] Queensland Department of Transport and Main Roads. Cost–benefit analysis manual. Brisbane: State of Queensland (Department of Transport and Main Roads); 2011.
[18] Australian Bureau of Statistics. Consumer price index inflation calculator. 2017. Available at: http://www.abs.gov.au/websitedbs/d3310114.nsf/home/consumer+price+index+inflation+calculator [verified 9 May 2017].
[19] Queensland Corrective Services Correctional employees’ certified agreement 2016 – matter no. ca/2016/158, Industrial Relations Act 1999 – s. 156. Certification of an agreement. Department of Justice and Attorney General. Queensland: Division of Queensland Corrective Services and Together Queensland – Industrial Union of Employees. 2016.
[20] Australian Taxation Office. Taxation determination – reasonable amounts for 2015–16. Canberra: Australian Government; 2015. Available at: https://www.ato.gov.au/law/view/document?DocID=%22TXD%2FTD201514%2FNAT%2FATO%2F00001%22&PiT=99991231235958 [verified 12 May 2017].
[21] Caffery LJ, Taylor M, Lucas K, Smith AC. Substitution rates of video consultations for traditional consultations at a tertiary public hospital. J Telemed Telecare 2016; 22 453–8.
| Substitution rates of video consultations for traditional consultations at a tertiary public hospital.Crossref | GoogleScholarGoogle Scholar |
[22] Lloyd AR, Clegg J, Lange J, Stevenson A, Post JJ, Lloyd D, Rudge G, Boonwaat L, Forrest G, Douglas J, Monkley D. Safety and effectiveness of a nurse-led outreach program for assessment and treatment of chronic hepatitis C in the custodial setting. Clin Infect Dis 2013; 56 1078–84.
| Safety and effectiveness of a nurse-led outreach program for assessment and treatment of chronic hepatitis C in the custodial setting.Crossref | GoogleScholarGoogle Scholar |
[23] Harno K, Arajarvi E, Paavola T, Carlson C, Viikinkoski P. Clinical effectiveness and cost analysis of patient referral by videoconferencing in orthopaedics. J Telemed Telecare 2001; 7 219–25.
| Clinical effectiveness and cost analysis of patient referral by videoconferencing in orthopaedics.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mvmt1Cnsg%3D%3D&md5=4a3191df54d6816dfe7d876fd0b59938CAS |
[24] Haukipuro K, Ohinmaa A, Winblad I, Linden T, Vuolio S. The feasibility of telemedicine for orthopaedic outpatient clinics – a randomized controlled trial. J Telemed Telecare 2000; 6 193–8.
| The feasibility of telemedicine for orthopaedic outpatient clinics – a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3cvnslSmtw%3D%3D&md5=71bb9176efa23f53f9178bed65754ee3CAS |
[25] Wan AC, Gul Y, Darzi A. Real-time remote consultation in the outpatient clinic – experience at a teaching hospital. J Telemed Telecare 1999; 5 70–1.
| Real-time remote consultation in the outpatient clinic – experience at a teaching hospital.Crossref | GoogleScholarGoogle Scholar |
[26] Tachakra S, Hollingdale J, Uche CU. Evaluation of telemedical orthopaedic specialty support to a minor accident and treatment service. J Telemed Telecare 2001; 7 27–31.
| Evaluation of telemedical orthopaedic specialty support to a minor accident and treatment service.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7msFChuw%3D%3D&md5=fe1f3d857243f9336532199220e713f3CAS |
[27] Roccia F, Spada MC, Milani B, Berrone S. Telemedicine in maxillofacial trauma: a 2-year clinical experience. J Oral Maxillofac Surg 2005; 63 1101–5.
| Telemedicine in maxillofacial trauma: a 2-year clinical experience.Crossref | GoogleScholarGoogle Scholar |
[28] Barry CJ, Henderson C, Kanagasingam Y, Constable IJ. Working toward a portable tele-ophthalmic system for use in maximum-security prisons: a pilot study. Telemed J E Health 2001; 7 261–5.
| Working toward a portable tele-ophthalmic system for use in maximum-security prisons: a pilot study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MrhsF2gtg%3D%3D&md5=4a278b7d6fbc7a4c23560908e5ed3486CAS |
[29] Yogesan K, Henderson C, Barry CJ, Constable IJ. Online eye care in prisons in Western Australia. J Telemed Telecare 2001; 7 63–4.
| Online eye care in prisons in Western Australia.Crossref | GoogleScholarGoogle Scholar |
[30] Larsen D, Stamm BH, Davis K, Magaletta PR. Prison telemedicine and telehealth utilization in the United States: state and federal perceptions of benefits and barriers. Telemed J E Health 2004; 10 S-81–9.
| Prison telemedicine and telehealth utilization in the United States: state and federal perceptions of benefits and barriers.Crossref | GoogleScholarGoogle Scholar |
[31] Anogianakis G, Ilonidis G, Milliaras S, Anogeianaki A, Vlachakis-Milliaras E. Developing prison telemedicine systems: the Greek experience. J Telemed Telecare 2003; 9 4–7.
| Developing prison telemedicine systems: the Greek experience.Crossref | GoogleScholarGoogle Scholar |
[32] Leonard S. The successes and challenges of developing a prison telepsychiatry service. J Telemed Telecare 2004; 10 69–71.
| The successes and challenges of developing a prison telepsychiatry service.Crossref | GoogleScholarGoogle Scholar |
[33] Frakt AB. How Much Do Hospitals Cost Shift? A Review of the Evidence. Milbank Q 2011; 89 90–130.
| How Much Do Hospitals Cost Shift? A Review of the Evidence.Crossref | GoogleScholarGoogle Scholar |
[34] Commonwealth of Australia. Rates and taxes: a fair share for responsible local government Canberra: Commonwealth of Australia; 2003.
