Background: Regulation of a global market by regional licensure systems and trade barriers has significant drawbacks.
Methods: Literature review of telemedicine, law and economics.
Results: Today's patients are willing to use out-of-pocket dollars to purchase medical care from: (a) foreign physicians in the medical tourism market; and (b) nurse-practitioners in pharmacy clinics. As telemedicine comes of age, patients are likely to purchase more health care from foreign telemedical 'pharmacy' clinics to avoid the costs, and the hassle, of travel. Many of these foreign medicine providers are likely to be unlicensed. This is problematic because experience with Mydoc.com and Usanetrx.com demonstrates that today's patients are relatively unconcerned with the licensure status of telemedicine providers. Accordingly, the elements of a black market in telemedicine may be on the horizon. Strengthening medical licensure laws is unlikely to keep foreign providers out the US health care market forever. Alternatively, one method to minimize the size of a black market in telemedical services would be to allow the market to regulate itself through the creation of a commodities-type exchange.
Conclusion: Now is the time to open a global dialogue on how to regulate telemedicine.
(c) 2008 John Wiley & Sons, Ltd.