Online continuing medical education (CME) for physicians can be carried out via telemedicine systems. Telemedicine systems thus offer new ways to practice medicine and enable the remote delivery of personal health services, continuing medical education, and patient health education [
An extensive international literature has reported on the efficacy of telemedicine [
However, the provision of more online CME might crowd out the time that a physician can devote to medicine practice and thus worsen the health status of his or her patients. The relation between online CME and health may thus be nonmonotonic, and there could be an optimum amount of online CME that can achieve sustainable improvements in health. Public health researchers use life expectancy at birth as a good proxy that reflects population’s health [
Our study contributes to and improve upon earlier studies in the following ways. First, our outcome measure of life expectancy on the effects of online CME via telemedicine permits us to estimate the optimal provision of telecommunications health professionals. Second, this study is among the first to integrate technology development and healthcare provision to highlight the effectiveness of online CME via telemedicine in sustainable health improvement. Third, the telemedicine system in Taiwan is a good model system that other countries can learn from when seeking to provide the accessibility and affordability of healthcare for rural residents as well as health professionals for remote physicians. This study thus aims to investigate what factors affect online CME provision in healthcare systems and what the optimal online CME lectures are for improving health.
The telemedicine program provides real time teleconferencing, transfers medical data for consultation, and increases confidentiality of health workers and patients in remote areas. The CME lectures that are provided through the educational technology system may be affected by the healthcare system as a whole, including factors such as telecommunications and face-to-face programs used, as well as medical resource concerns, including per capita gross domestic product (GDP) and per capita national health expenditure (NHE). The online CME that is provided could thus be a function of the following factors:
Physicians spend time on CME activities to cover the full range of topics important to their professional development. Research has shown that CME is an effective tool for changing physician practices and improving patient care [
The subjects of this study are to examine the following:
In econometrics, panel data can contain multidimensional data and observations on multiple phenomena observed over multiple time periods for the same hospitals or patients [
In Taiwan, telemedicine services were first introduced in 1995 for physicians in remote sites in order to provide healthcare in rural areas. Such services included online CME for physicians and special medical services for the elderly, the handicapped, and terminally ill patients at home. The National Health Insurance (NHI) system was established in the same year, and enrollees enjoy almost free access to healthcare, with only a small copayment in most clinics and hospitals. However, in 2004, a telemedicine cost-benefit analysis conducted by the government cast doubt on the effectiveness of the system, and now its provision is limited to a number of qualitative pilot experiments.
Based on (
Based on (
The panel datasets of dependent and explanatory variables are observed over the period 1995–2004 and are regarded as a national sample. This research is thus a retrospective study. The mentioned variables are collected from the Ministry of Health and Welfare and the Ministry of Interior, Taiwan. Table
Summary statistics.
Variables | Average | Std. deviation | Minimum | Maximum |
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Tel. care | 182.46 | 155.2 | 25 | 645 |
Tel. exp. | 166485 | 182218 | 9062.5 |
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Per capita GDP | 13545 | 607.05 | 12769 | 14663 |
Per capita NHE | 751.26 | 58.8 | 636.36 | 848.00 |
Online CME lectures | 1344.5 | 1221.05 | 100 | 3066 |
Life exp. | 75.75 | 0.47 | 74.85 | 76 |
Con. services |
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607.05 |
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Con. Ex. |
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1356.5 |
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The panel data regression estimated results for the provision of online CME lectures and other selected variables are presented in Table
Regressions of online CME on selected variables.
Number of observations = 50 | ||||||
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Period of test = 1995–2004 | ||||||
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Root MSE = 301.91 | ||||||
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adjusted |
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Online CME | Coef. | Std. err. |
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95% conf. interval | |
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Tel. care | 0.499 | 0.274 | 1.82 | 0.075 |
−0.053 | 1.052 |
Per capita GDP | −1.531 | 0.097 | −15.731 | 0.000 |
−1.726 | −1.335 |
Per capita NHE | 22.395 | 1.320 | 16.97 | 0.000 |
19.736 | 25.053 |
Con. services |
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4.02 | 0.000 |
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Constant | 2520.839 | 1005.661 | 2.49 | 0.017 |
477.334 | 4528.344 |
Online CME: continuing medical education via telemedicine; tel. care: the quantity of telemedicine health services; per capita GDP: per capita gross domestic product; per capita NHE: per capita national health expenditure; and con. services: conventional health services.
Per capita GDP negatively affects the number of online CME lectures provided via telemedicine. This is because with higher incomes the use of CME lectures via telemedicine may be substituted by a synthesis of different types of knowledge, which can be seen as a form of continuous medical training. Economic development is thus associated with decreases in the provision of online CME lectures. A 10% increase in the provided health services via telemedicine increases the provision of online CME lectures by 4.99%. The statistics for
Based on (
Based on the statistics provided in Table
The relationship between telemedicine healthcare and the provision of online CME lectures.
The main concern of this study is to explore the influences of healthcare factors on health status and to find out the optimum of the online CME lectures that should be provided. The multiple regression results for the application of health status to selected variables are presented in Table
Regressions of life expectancy at birth on selected variables.
Number of observations = 50 | ||||||
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Period of test = 1995–2004 | ||||||
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Root MSE = 0.00677 | ||||||
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adjusted |
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Life Exp. | Coef. | Std. err. |
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95% conf. interval | |
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Online CME |
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Online CME square |
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Tel. Ex. |
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Tel. Ex. square |
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Con. Ex. |
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Con. Ex. square |
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Tel. care |
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Con. services |
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Per capita GDP |
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Constant |
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Life exp.: life expectancy at birth; online CME: continuing medical education via telemedicine; online CME square: the square of online CME; Tel. Ex.: the expenditure on telemedicine in millions of US dollars; Tel. Ex. square: the square of Tel. Ex.; Con. services: conventional health services; Con. Ex.: conventional health expenditure in millions of US dollars; Con. Ex. square: the square of Con. Ex.; tel. care: the quantity of telemedicine health services; and per capita GDP: per capita gross domestic product.
We are interested in the nonlinear relationship between the provision of online CME lectures with health status. Based on (
Differentiating (
The relationship between online CME lectures provided via telemedicine and life expectancy.
This research has discussed the effective ways of online and telemedicine system of medical services as well as presents rationale and need for online CME and provides evidence of online CME effects on health improvement. Subject investigated is current and relevant as governments decide to adopt and implement such mechanisms in technology and healthcare provision. Moreover, to our knowledge, the existing literature has not discussed the health sustainability of online CME via telemedicine.
A nonlinear online CME-health nexus exists. Increases in the provision of online CME lectures are not necessarily associated with better health status once the provision exceeds the optimal level. However, the results show that the real provision of online CME lectures in Taiwan is currently too low. The contributions of CME, a major facilitator of changes in practitioner behavior, are currently underprovided due to difficulties in CME delivery at remote sites. Moreover, the measures for health attainment could be partially viewed as being determined by the attainment of the appropriately providing online CME lectures. This research also finds that higher income could be associated with worse health, and health fast lane effects could explain fast rising health expenditures in developing and developed countries [
Telecommunications access is an increasingly important prerequisite to exploiting social, economic, and educational opportunities [
The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The author declared no potential conflict of interests with respect to the research, authorship, and/or publication of this article.
This work was supported by grants from the Ministry of Science and Technology of Taiwan (Grants nos. MOST 103-2410-H-006-086-, MOST 104-2410-H-006-109-, and MOST 105-2410-H-006-091).