Health care entrepreneurs working outside the traditional health insurance payment system are using telephone, e-mail, text messaging and innovative computer software to make medical care more accessible and convenient for patients, according to a new study by the National Center for Policy Analysis (NCPA).

"Patients often find it difficult to take time off work to see a doctor," said NCPA Senior Fellow Devon Herrick, who authored the study.  "In the Information Age, location doesn't matter."

The study notes that the biggest obstacle to Information Age medicine, commonly referred to as telemedicine, is government and traditional insurance, which only reimburses for face-to-face consultations. Therefore, the most interesting developments in telemedicine are occurring outside traditional insurance, both by new medical services and by individual practitioners. For example:

  • Approximately 1 million patients are now subscribers to a nationwide service operated by TelaDoc Medical Services (  For a low $35 consultation fee, enrollees can talk to a doctor by phone, any time day or night.
  • TelaDoc maintains electronic medical records that are available online, allowing physicians access to patient records anywhere in the country and ensuring accuracy.
  • Virginia physician Dr. Alan Dappen also practices telemedicine.  Patients can schedule an appointment or e-mail him from his Web page (  
  • Dr. Dappen bills patients in five-minute increments ranging from $25.50 for in-office visits to $17 for phone consultations.  His office assists patients with insurance billing and also allows them to pay using PayPal.

Telemedicine provides important new opportunities to improve health care and overcomes a wide range of problems in the traditional health care system. For example:

  • Doctors are hard to see. As many as one in three patients have trouble seeing a primary care physician, and nearly one in four have problems taking the time from work to see their doctor.
  • More than half of all emergency room (ER) visits are for nonemergency health problems. ER visits are extremely costly and could easily be avoided if patients could contact health care professionals by phone or by e-mail at any time or day of the week. 
  • More than 125 million Americans have chronic conditions, yet most are not receiving appropriate care, in part because monitoring is complex and expensive. Yet programs to manage chronic medical conditions are beginning to use remote monitoring, which research has shown improves patients' adherence to protocols and can be outsourced to low-cost, qualified medical providers.
  • The use of electronic medical records improves the quality of care and reduces medical errors, allowing better coordination of patient care among different providers.

"Health insurers and the government are keeping the practice of medicine in the Stone Age," said Herrick.  "Telemedicine provides patients with convenient high quality care for a lower cost."