08 March 2012


EconLog | Arnold Kling | Videoconferencing and Health Care

Scott Gottlieb writes,
A patient recently asked me why doctors don't spend more time communicating over email or by videoconferencing.

There's a simple answer: Medicare hasn't created a billing code for these services.
I would love to stand up and cheer. But I think this is not a good example. [...]

However, in the particular case of videoconferencing, I think the problem is that this is still perceived as bleeding-edge technology [not a problem with billing]. I brought this up during the video conference with Hal Varian and Nick Schulz. Hal and I remember the 1990's, when corporations first connected to the Internet, and managers dealt with email by having their secretaries print it out for them. They were wary of the new technology and unwilling to really dive into it. That is where most people are with videoconferencing right now.

When that changes (assuming it does), a lot of habits will change. People will spend less time going to and from meetings. Instead, they will hop from meeting to meeting with a click of a button, sitting at their computers. This will save a lot of time.
I actually don't think videoconference meetings will save much time. I predict for most people it will lower the time cost of each individual meeting, but it will increase the overall number of meetings that they must "attend" precisely because the cost of each has gone down.
Hypothesis – Because it is difficult to decline to attend a meeting, or to get one canceled once proposed, the number of meetings a group has is a function of the appetite for meetings of the person who is most enthusiastic about meetings. This will only get worse with video-conferencing, because it will become harder to claim you can't make the meeting.

Let me use Kling email's example. Ten years ago when I was finishing K12 it was inconceivable that my parents would send weekly emails to any of my teachers. All of my teachers had email accounts provided by the school, and these addresses were all public, but it just wasn't a way they communicated with parents. If my parents wanted something from a teacher they either had to arrange a face-to-face meeting, which was costly, try to connect on the phone, which meant taking time out of their own workday afternoons, or give me a message to bring to school. The latter was the most common.

Mrs SB7 is now teaching in the same school district I attended. She spends about an hour a day responding to parent email. By and large, these are not terribly critical questions she is forced to field. Most of this communication does not need to happen at all, in any medium, electronic or otherwise. They're mostly of the form "When is Johnny's homework due?" and "Why did you deduct points from Sally's paper just because it was half the length is was supposed to be?" These are questions that do not need to be asked, and if they do, are exactly the sorts of things a teenager ought to learn to walk into school and ask for themselves.

Part of this increased email usage is because of the particular mix of special needs students Mrs SB7 teaches. Part of it is probably a cultural shift which has made hovering/helicoptering/dragon-mothering more common, but don't forget we're looking at a ten year period in one community, so the culture shouldn't have changed that much. Because the cost of asking teachers questions is now so low there are far, far, far more questions asked. From what I can tell email with parents has decreased rather than increased the productivity of teachers. I suspect the same would happen if it became common to expect to be able to videoconference with a teacher. (Or most other people, for that matter.)

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