House Calls Around the World
For centuries, house calls were the primary way patients accessed care around the world. Doctors would travel with a portable medical kit to patient’s homes to treat their illness. Post-World War II however, house calls fell out of favour. In the United States, for example, house calls comprised over 40% of physician encounters. By the 1980s, they comprised only 1%. Medical care became increasingly institutionalized, higher productivity was the goal and with the rise of cars, patients were able to get to the doctor more easily than ever before. But this wasn’t the case everywhere. In some countries, like France, house calls never went away. In many others, they’re making a comeback as both physicians and patients are starting to realize how effective it is at keeping citizens out of the hospital. Let’s take a look and check out house calls around the world.
Sylvia Sabes, an American expat living in Paris, had just moved to France when her two kids fell ill with fever and strep throat. She called SOS Médecins, a team of mobile emergency care doctors, and an English-speaking doctor was at their apartment in 20 minutes. He did a check-up, prescribed antibiotics, and charged her 78 Euros (for French citizens house call visits are reimbursed by the country’s universal health insurance plan, similar to our OHIP).
How refreshing! Her children could recover peacefully at home and avoid infecting others in the waiting or emergency room.
The World Health Organization ranks France as having the best overall health care in the world.
Yet, they spend half the amount that U.S. does. Could part of the reason be that they avoid costly hospitalization whenever possible? The U.S sends its citizens to hospitals at a rate 2.5 times more than France does. Part of that reason is that house calls in France, unlike in the U.S and Canada, never left the health care system.
SOS Médecins has over 1,000 full-time doctors, working through 60 regional associations and covering two-thirds of the country. They take more than 4 million calls per year and visit about 2.5 million homes.
Doctors love it since they get to see inside the home which provides information that they wouldn’t get from an office visit. For example, if an elderly person keeps injuring himself, the doctor can identify risk factors in the home, like an uneven step, and make recommendations to prevent future occurrences. The government loves it because it reduces the burden on emergency rooms and ambulance services.
Dr. Mateen Jiwani of England sees as many as 80 patients a day at the public hospital where he works. But once a week he does house calls through an app, GPDQ. Why? Because he feels it allows him to practice better medicine.
“If I’ve got 10 minutes to do something, I am not going to do exactly the same thing as if I have 25 minutes,” Jiwani told the CBC. “There’s no pressure. My whole manner has changed.”
The UK has seen a recent resurgence in house calls in both its public and private sector health care.
On the public side, England’s government is under pressure to reduce waiting times in emergency rooms — they can be up to 9 hours long. To solve the crisis, they’re encouraging physicians to make home visits to reduce unnecessary emergency room visits
On the private side, several Uber-like houses call apps have cropped up in the last few years in the UK.
Dr. Achim Mortsiefer practices medicine in one of Germany’s oldest cities, Cologne. Many afternoons he’ll lock up the doors of his office and set out to visit patients at their homes.
Germany has universal health care, funded by both taxes and private insurers, and Mortsiefer will make about 20 Euros per house call. But Mortsiefer doesn’t care so much about that — he finds the visits meaningful since he’s helping the elderly and people with accessibility issues.
“The problem is,” he tells NPR, “if you think about money the whole day you will be unhappy. That’s an old rule of life, isn’t it?”
Like France, house calls never left Germany. The average GP makes 34 home visits per week, and they’re still an integral aspect of primary care.
Rebecca Murad, a 39-year-old architect who lives near the Amazon, was on vacation in São Paulo, Brazil when her 4-year-old daughter fell ill with a fever. She wasn’t comfortable with waiting in an unknown hospital, so she used the Beep Health app to get a doctor to visit her home.
These Uber-like house call apps have proliferated in Brazil’s private sector health care in the last few years.
Vander Cortez, the founder of Beep Health, has 750 active doctors registered on his app. He wants to simplify the process of home visits and unburden the public health care sector.
Malaysia has world-class health care with clean, modern facilities and highly-trained doctors. In fact, it’s a top destination for medical tourism.
With such an advanced technological scene and a massive consumer demand for smartphones, it was inevitable that start-ups would capitalize on the environment and start the Uber-style house calls apps so popular in other countries.
Two companies, Door2Door Doctor and HomeGP Asian seek to allow patients to avoid traffic jam woes, clinic queues, and having to take time off from a busy work schedule to tend to a sick loved one. Both have highly-trained and experienced doctors who are on-call 24 hours a day and 7 days a week—all to provide non-emergency medical care that includes visits by physicians, nurses, and physiotherapists.
With at least 1.5 million Malaysian households having either aging parents, young children, or bedridden family members requiring health care, home visits are sure to increase in popularity.
Total health expenditure in the Great White North is expected to reach a total of $228.1 billion (or $6,299 per Canadian) in 2016, according to a report by the Canadian Institute for Health Information. Canada’s per capita health care spending is among the highest internationally, with hospitals accounting for the largest category of spending. The government is under pressure to reduce this spending, as the health care system is entirely funded by taxpayers.
Hospitals were designed for acute treatment – things like a broken bone or meningitis – but have evolved into centres that treat chronic conditions and provide continuing treatment.
Patients also have trouble getting hold of their physician after-hours when they’re ill. The stats back this up – only 43% of Canadians report that they were able to get a same- or next-day appointment at their regular place of care the last time they needed medical attention. That’s the lowest percentage of all 11 developed countries surveyed. And even less, just 34%, said they were able to get care after regular business hours.
That means more than 1.4 million visits to emergency rooms could have been potentially avoided, reports a 2014 study by the Canadian Institute for Health Information, for conditions that could have been easily treated by a doctor.
That might explain why the government gives bonuses and premiums to physicians who do home visits – our government knows that house calls are far, far cheaper than visits to the hospital.
That’s exactly why MediSeen was created – the only digital house call platform of its kind in Canada. Starting in August, users can simply open the MediSeen app and schedule an appointment with a health care provider they select — they have doctors, nurses, chiropractors, massage therapists, physiotherapists, and more, who live in their community and are eager to help. With MediSeen, there are no more waiting rooms. MediSeen promises to increase access to quality care and allow patients to heal at home.