Telehealth works but rules need changing

With its services skyrocketing during the COVID-19 pandemic, telehealth—where medical services are delivered by phone or video call—has become a mainstay of health care systems in Australia and other countries around the world.

Now, new research led by Flinders’ Dr. Maria Alejandra Pinero de Plaza has investigated how well it works for those who are homebound, unable to leave due to chronic illness, disability, frailty, or mental health conditions.

“Telehealth is not just a convenience, it’s a lifeline,” says Dr. Pinero de Plaza, from Flinders University’s Caring Futures Institute.

“Yet, despite its proven benefits, many Australians remain excluded from accessing telehealth services because of outdated Medicare requirements.”

Published in the journal Health & Social Care in the Community, the first-of-its-kind global systematic review and meta-analysis found the service reduces hospital visits, improves mental health, and helps people feel more connected to their communities.

It was also found to improve quality of life by reducing pain, enhancing mental health, and increasing social engagement, as well as helping to alleviate depression, anxiety, and loneliness.

Despite these benefits, the authors note that Medicare still requires most patients to have seen their GP in person within the past 12 months to qualify for telehealth rebates, highlighting that for truly homebound individuals, this is often impossible.

“Our research clearly demonstrates the effectiveness of telehealth, but the current system is failing the very people it was designed to help,” says Dr. Pinero de Plaza.

“There are over half a million Australians who are homebound, and many of them are invisible in our health system.”

The researchers are calling for the removal of Medicare’s in-person requirement for those who are homebound and increased funding for telehealth services.

Other changes should also include more formal data collection of homebound individuals to see them recognized in health policy, alongside collaboration with homebound people and their caregivers to ensure the services meet real-world needs.

“One of the challenges is that Australia does not yet have a national definition of what it means to be homebound, and there is no consistent way to identify these individuals in routine data,” says Dr. Pinero de Plaza.

“We need to improve data collection to support evidence-based and equitable reforms that would allow Medicare to implement a targeted exemption.”

The study also highlights the diversity of the homebound population, with a 2020 Australian survey finding, contrary to common assumption, that many are not elderly but in fact are likely to be women and aged under 50. Common conditions included ME/CFS, advanced cancer, and severe mental illness.

“Every day, homebound Australians are missing out on care that could help them live better, safer lives,” says Dr. Pinero de Plaza, “but until Medicare rules are updated, thousands of Australians will continue to miss out.

“This finding is significant, not just for Australia but for all populations where telehealth can be made available.

“The message is clear: Telehealth works. It keeps people healthier, safer, and more connected. It saves health resources and improves lives and health policies around the world should ensure its accessibility.”

This research builds on a body of work focused on the invisibility and unmet needs of Australians who are homebound due to chronic illness, disability, or frailty, including those with ME/CFS.

It stems from the Visibility and Technological Solutions for Frail, Homebound and Bedridden People (FHBP) research program at the Caring Futures Institute and draws on themes from the ENLIGHTEN: homEbouNd peopLe agInG witH TEchNology online exhibition, which featured public and scholarly engagement on FHBP systemic exclusion.

Together, these initiatives have helped frame national conversations around inclusion and policy reform for some of the most isolated populations.