The Use of Telemedicine Technology and Restructured Referral Patterns to Reduce Health Care Costs in a Juvenile Justice System

The study objective was to examine the cost-effectiveness and cost savings of a telemedicine program in four adolescent detention facilities in Tennessee. The facilities, in rural communities with limited access to specialty health care resources, implemented a telemedicine and referral program that obtained care from an academic medical center. The study measured costs for specialty outpatient, emergency department, and inpatient visits, and for transportation and security required to obtaining health care. Comparison of costs for the year before and after implementation found telemedicine to be associated with significant increases in overall costs per encounter, 34.58%; outpatient costs, 53.76%; inpatient costs, 22.08%; and emergency room costs, 149.71%. There was a negative relationship for five cost measures when level of telemedicine implementation at individual facilities was examined. The authors conclude that although introduction of telemedicine may lead to an overall increase in costs related to increased access, evidence indicates that higher levels of telemedicine utilization yield lower average costs.