Abstract

A committee was established by the International Telecommunication Union in 1994 to study telemedicine, with particular reference to developing countries. A questionnaire was used to gather data. Fifty-eight responses were received, two-thirds from developing countries. In most developing countries the user did not pay for the telemedicine service, at least not directly. There were few instances of a commercial telemedicine service, and in most countries the telemedicine service was subsidized by the government or another party. The telemedicine 'value chain' describes how equipment suppliers, telecommunications operators and health-care professionals deliver their products or services to the client, who is eventually the ultimate user. Quite different configurations are conceivable, and an analysis of what could be a sustainable, cost-effective value chain in developing countries is required. It is clear that the rapidly growing interest in telemedicine challenges the leaders of the medical establishment to rethink the ways they provide their services and to address the medical needs of areas where such services are absent or in short supply.

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