What is the effect of physical examination requirements on mortality rates?

Is tele-medicine/internet-medicine the wave of the future?  Or do these alternative treatment methods just make it easier for patients and providers to engage in fraudulent and/or unsafe behaviors?

In response to concerns about tele-medicine’s effect on patient safety, many states have begun prohibiting physicians from prescribing drugs without conducting a prior physical examination. In fact, more than 30 states have instituted this type of rule since 1998.

A paper by Cotet and Benjamin investigates this regulation which they call the physical examination requirement (PER).  They hypothesize that:

“The imposition of the PER thus created a tradeoff between access and safety (or quality) in the provision of healthcare services. By raising the implicit cost of nontherapeutic use of potentially harmful drugs (such as Oxycontin) and by improving diagnoses, PER offered the promise of higher quality care. However, the PER also slowed the diffusion of telemedicine, making it more difficult and more costly for patients to receive care.”

To evaluate the impact of PER, Cotet and Benjamin use a difference-in-difference empirical strategy to compare changes in mortality for states that adopted PER and against changes in mortality among states that did not (also controlling for changes in state and county characteristics over time).  Applying this strategy to the Compressed Mortality Files—for mortality measures—and the Behavioral Risk Factor Surveillance System (BRFSS)—for morbidity measures, the author conclude the following:

“The adoption of PER is associated with a 1% rise in disease-related mortality rates the equivalent of 8.5 deaths per 100,000 people, presumably because it raised the implicit cost of, and thus reduced access to, medical care. In addition, the adoption of the PER is associated with a 6.7% reduction in injury-related mortalities, the equivalent of 2.5 deaths per 100,000 people. Thus, the reduction in injury mortality is smaller than the elevation of disease-related mortality, yielding a rise in overall mortality.”

Source:

• Cotet, A. M. and Benjamin, D. K. (2012), MEDICAL REGULATION AND HEALTH OUTCOMES: THE EFFECT OF THE PHYSICIAN EXAMINATION REQUIREMENT. Health Econ.. doi: 10.1002/hec.2807