Rationale Telemedical capabilities in prisons and other settings offer the prospect of expanding access to health care providers. The information so communicated can be as limited as a written report of laboratory tests. Specialists can also remotely direct general physicians in the treatment of patients so presented. Telemedicine s ability to broaden the supply of health care providers has the potential to overcome some of the barriers to effective prison health care that result from the structure of the American health care industry. This industry is characterized by a high degree of physician specialization, which results in patient care being provided by a number of different primary care physicians and specialists, all of whom may not be associated with formal organizations or networks.
Physician specialization has significant implications.
Whereas the practice of an individual primary care physician requires a population base of between 3,000 and 5,000 people to support it, the population required to support certain types of specialists is much larger. Indeed, for some specialties, the required base exceeds the populations of many large urban centers. Second, in regions where specialists are rare, those who do exist acquire monopolistic powers over consumers. If, by virtue of installing telemedical communications equipment, a remotely located health care provider can communicate directly with specialists located elsewhere, the consumer s leverage in the marketplace becomes greater. Consumers are no longer limited to the locally available medical care.