title: Policy determinants affect telehealth implementation.
abstract: The objective of this study is to explore the variation in the implementation of telehealth programs in the United States. In researching this topic, we assess the influence of traditional policy determinants on the extent of telehealth program implementation. The methodology used in our evaluation is cross-sectional time series regression analysis. The main dependent variable is the extent of telehealth program implementation at the state level across 29 medical specialty areas from 1995 through 2003. The results suggest that state legislative professionalism, partisanship of state legislators, government resources, and severity of need are important factors in understanding the implementation of this policy. We also find healthcare interest groups to be associated with telehealth program implementation, with nursing groups positively related to implementation, and physician networks negatively associated. In one respect, finding interest groups as significantly related to implementation is not surprising; interest groups are important to the policy landscape of the United States. On the other hand, telehealth is a procedural policy that essentially dictates how policy is to be carried out. Generally, this form of policy does not attract public interest. In this circumstance, the interest groups who mobilized are the individuals who must carry out the policy. This outcome reminds us that although the policy literature does not treat interest groups as important to execution of procedural policy, we must consider how these policies will impact those who must carry them out. As an interest group, they can either act as an impetus or barrier to implementation.
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH 44195, USA. schmeim@ccf.org
authors.forename: Mary
authors.initials: M
authors.lastname: Schmeida
authors.forename: Ramona
authors.initials: R
authors.lastname: McNeal
authors.forename: Karen
authors.initials: K
authors.lastname: Mossberger
mesh_terms: D003430:Cross-Sectional Studies; D005380:Financing, Government / Q000458:organization & administration; D006291:Health Policy; D006301:Health Services Needs and Demand / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D011057:Politics; D012044:Regression Analysis; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration*; D014481:United States