JMIR Publications

ABSTRACT

We read the recently published article titled “Issues in the Adoption of Online Medical Care: Cross-Sectional Questionnaire Survey” by Sugawara Y et al [1] with great interest. The authors conducted two surveys aimed at identifying the current status of telemedicine in Japan and the factors hindering its spread, from the perspectives of both patients and medical professionals providing it. Although the existence of bias cannot be denied because of the web-based voluntary survey, the findings were useful in understanding the current status of telemedicine in Japan. As corrected in the original paper, the authors cited our study [2] and explained that telepsychiatry was reimbursed at the same or higher rate as in-person consultations in 15 of 17 regions in the world. In this study, Japan was positioned in the minority, with telepsychiatry reimbursement distinctly lower than face-to-face care. This has continued to be an obstacle to the widespread use of telemedicine in Japan, not only in psychiatry, but even before 2019 and after deregulation after the COVID-19 pandemic, as reimbursement prices for telemedicine are lower than face-to-face reimbursement [3]. In addition, telepsychiatry is more strictly regulated than telemedicine in other medical specialties, and even after the latest deregulation in June 2024, there are still restrictions on prescription drugs and reimbursement prices for initial visits, as well as restrictions on the conditions for physicians and medical facilities to obtain reimbursement. The survey by Sugawara et al. showed that patients and healthy people in psychiatry and psychosomatic medicine want to use telemedicine, but the fact that medical institutions are unable or unwilling to provide it in the first place due to such strict regulations is surely the biggest obstacle to its widespread use. In addition, Sugawara et al. state that it is necessary to obtain the opinions of psychiatrists and psychosomatic medicine specialists regarding the feasibility of online medical care. In a 6-month RCT of 199 patients with depression, anxiety, and obsessive-compulsive disorder at 19 medical institutions in Japan, we verified the non-inferiority of the combined telepsychiatry group to the face-to-face treatment group [4]. The study also found no significant differences between the two groups on a number of secondary endpoints, including treatment retention and satisfaction, and confirmed that the telepsychiatry group required less time and cost less than the face-to-face treatment group. From these studies, we believe that the feasibility of telepsychiatry in the Japanese medical field has already been verified to a certain extent. In Japan, while the demand for medical care is expected to increase due to further aging of the population, the dispersion and maldistribution of physicians and hospitals has not been resolved [5]. Since telemedicine is considered effective as a measure to improve efficiency and equalize the provision of medical care, the government should ease regulations to make it easier for frontline medical professionals to use.