Radiology Services for Remote Communities: Cost Minimisation Study of Telemedicine

Objectives: To determine the social costs of providing a rural population with radiology services under three different systems: the existing system (a small x ray unit at the remote site and all other examinations at the nearest radiology department (the host site)); a teleradiology system (most examinations at the remote site and more advanced examinations at the host site); and all examinations at the host site.

Design: Cost minimisation study.

Setting: Primary health care in a remote community in Norway.

Subjects: A randomly selected sample (n = 597) of all patients (n = 1793) having radiological examinations in 1993.

Main Outcome Measures: Annual direct medical costs, direct non-medical (travel) costs, and indirect costs (lost production) of the three options.

Results: After exclusion of costs common to the three systems the direct medical, direct non-medical, and indirect costs of the three options were, respectively, 9000 pounds, 51,000 pounds, and 31,500 pounds (total 91,500 pounds) for the existing system; 108,000 pounds, 2,000 pounds, and 13,500 pounds (total 123,500 pounds) for the teleradiology option; and 0 pounds, 75,000 pounds, and 42,000 pounds (117,000 pounds in total) for the "all at host" option. Sensitivity analyses indicated that the existing system is the least costly option except when lost leisure is valued as highly as lost production.

Conclusion: The teleradiology option did not seem to be cost saving in the study community. Such systems, however, may be justified on the grounds of equity of access and quality of care.