title: A cost comparison of travel models and behavioural telemedicine for rural, Native American populations in New Mexico.
abstract: OBJECTIVE
  The purpose of this study was to model the cost of delivering behavioural health services to rural Native American populations using telecommunications and compare these costs with the travel costs associated with providing equivalent care.
  
  
  METHODS
  Behavioural telehealth costs were modelled using equipment, transmission, administrative and IT costs from an established telecommunications centre. Two types of travel models were estimated: a patient travel model and a physician travel model. These costs were modelled using the New Mexico resource geographic information system program (RGIS) and ArcGIS software and unit costs (e.g. fuel prices, vehicle depreciation, lodging, physician wages, and patient wages) that were obtained from the literature and US government agencies.
  
  
  RESULTS
  The average per-patient cost of providing behavioural healthcare via telehealth was US$138.34, and the average per-patient travel cost was US$169.76 for physicians and US$333.52 for patients. Sensitivity analysis found these results to be rather robust to changes in imputed parameters and preliminary evidence of economies of scale was found.
  
  
  CONCLUSIONS
  Besides the obvious benefits of increased access to healthcare and reduced health disparities, providing behavioural telehealth for rural Native American populations was estimated to be less costly than modelled equivalent care provided by travelling. Additionally, as administrative and coordination costs are a major component of telehealth costs, as programmes grow to serve more patients, the relative costs of these initial infrastructure as well as overall per-patient costs should decrease.
authors.affiliation: Department of Economics, University of New Mexico, USA Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico, USA bhorn@unm.edu.
authors.forename: Brady P
authors.initials: BP
authors.lastname: Horn
authors.affiliation: Department of Economics, University of New Mexico, USA.
authors.forename: Gary N
authors.initials: GN
authors.lastname: Barragan
authors.affiliation: Albuquerque Area Indian Health Service, USA.
authors.forename: Chis
authors.initials: C
authors.lastname: Fore
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, USA.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Bonham
mesh_terms: D003153:Community Health Services / Q000191:economics; D017048:Health Care Costs; D006303:Health Services, Indigenous / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D007198:Indians, North American; D008605:Mental Health Services / Q000191:economics* / Q000458:organization & administration; D018803:Models, Economic; D009516:New Mexico; D012424:Rural Population / Q000706:statistics & numerical data; D017216:Telemedicine / Q000191:economics* / Q000458:organization & administration; D014195:Travel / Q000191:economics*
keywords: Telehealth; behavioural healthcare; economic; telemedicine; travel cost