Reimbursement in the private sector varies significantly. Clear, flexible, consistent reimbursement policies are needed. Development and Operating Cost. The start-up and operating costs of telemedicine systems are significant. The Telecommunications Act of 1996 provided Universal Service Fund telecommunications service discounts rural health providers.
Many rural communities lack the telecommunications infrastructure needed to support telemedicine.
For example, Sen. Lugar's office organized a meeting in April 1999 in Greencastle, Indiana, where participants noted that some rural areas simply do not provide the advanced, high-bandwidth telecommunications services required to support telemedicine. Telemedicine practitioners face unknown exposure to legal liability. Development of clinical standards for telemedicine interventions should allay concern and promote development of telemedicine applications. Telemedicine providers also face uncertainty. Clarification regarding acceptable collaborative relationships is needed in order to promote innovative partnerships in the development of telemedicine programs.