Telemedicine (TM) deserves serious consideration in the present economic situation.

In
such dire circumstances, social support offered though Transversal Units (TUs) is of
paramount importance, particularly if provided at a distance. This holistic endeavor merges
various healthcare services such as specialized, emergency, social, home-care, preventive,
pediatric and mental health care, all involving health transport, information technology (IT)
and pharmacy logistics.
Most TM programs rely on rudimentary technical solutions despite the availability of
simple state-of-the-art technology. Videoconferencing with new-generation HD1-TV-sets
that incorporate Internet allows medical and social assistance to be brought closer to users
at negligible cost (eg. using Skype). Nevertheless, willingness to pay (W2P) has been
identified as an element of success in USA1 .

In many EU countries, however, free and universal health-care is taken for granted and the
system is expected to provide primary care with limited waiting lists and nearby facilities.
Although primary care is being re-engineered, the major cause of patient dissatisfaction
stems from distance travelling and mushrooming waitlists in the context of specialized
care (secondary and tertiary care).
A recently published random trial of 800 patients2 illustrates this. Rural access to
specialists was provided Face to Face (F2F) or by TM videoconferencing. TM patients
showed equal quality of life but faster access, treatment and relief from pain. This
demonstrates the worth of a transversal health system which fuses primary and specialized
care by means of TM tools. Striking benefits have been shown by others in frail, chronic
and terminal patients3 . This strategy pursues WHO guidelines on innovative care for
chronic conditions.
Although W2P is a seldom-raised issue in universal health coverage systems, it becomes
relevant in additional services. SMS chronic disease management, for example, has been
left on hold because the burden of cost would be borne by users4 . The hollow argument
that SMS payment discriminates against disadvantaged patients represents a form of the

new Perssons dilemma2 on rationalist versus satisfactionalist attitudes. Unfortunately, the

consequence has been not to offer the service to anyone.
Perssons dilemma should never arise in 4P and 4T medicine. Predictive-PersonalizedPreventive and Participative medicine will be based on the IT tools provided by Telemedicine, Tele-control, Tele-management and Telemetry for anyone. These innovations
will boost transversal, integrated, social and healthcare delivery at a distance.

Faced with the challenge of reducing costs and improving performance, health managers
have no better alternatives than 4T-medicine.
BIBLIOGRAPHY

1. Stahl JE., Dixon RF. Acceptability and willingness to pay for primary care
videoconferencing: a randomized controlled trial. J. Telemed Telecare 2010; 16:147151.
2. Ferrer-Roca O., Garcia-Nogales A., Pelaez C. The impact of Telemedicine on Quality
of Life in Rural Areas: The Extremadura model of specialized care delivery.
Telemedicine and e-health 2010; 16:233-243.
3. Hernandez C, Jansa M, Vidal M, Nuez M, Bertran MJ, Garcia-Aymerich J, Roca J.
The burden of chronic disorders on hospital admissions prompts the need for new
modalities of care: a cross-sectional analysis in a tertiary hospital. QJM-Int J Med 2009;
102: 193-202.
4. Ferrer-Roca O. Mobile phone text messaging in the management of diabetes. J
Telemed Telecare 2004; 10:282-285 . doi:10.1258/1357633042026341.

Ingmar Persson, The Retreat of Reason: A Dilemma in the Philosophy of Life, Oxford University Press, 2005, 494 pp.,
ISBN 0199276900. Summary in: http://ndpr.nd.edu/review.cfm?id=7463