CLARIN

As Online Medicine Spreads, Doctors Push Back In Argentina

Doctors still make house calls in the South American country. But more and more, health care services providers are urging patients to try 'las videoconsultas.'

'So, what brings you online today?'
"So, what brings you online today?"
Vanesa López

BUENOS AIRES — You wake up with a cough or a cold. You call your healthcare provider and ask them to dispatch a doctor to your house. Instead, to your surprise, they suggest you try their new, online consultation service. You're curious. It sounds quick and easy, kinda cool even. So you accept, and a doctor appears on your phone screen.

One way or another, this is an increasingly common occurrence for Argentines as pre-pay health services use technology to complement or replace the traditional house calls with "video-consultations' at least for simple ailments.

The patient is given the option of receiving a home visit (as before) or speaking to a medic online on a computer, tablet or smartphone. "It's a fairly new practice, and growing about 40 to 50% a year," says Gabriel Barbagallo, president of ACTRA, the Argentinian Civil Association of Telemedicine, which promotes the use of remote medicine.

ACTRA's members include the healthcare services platforms OSDE, Medifé and Omint, among others. Barbagallo, who doubles as OSDE's institutional relations chief, says that all these firms now offer "some form of online consultation," be it video consultations, second opinions, referrals or remote assistance. "Telemedicine is much more than just video-consultations," he says.

OSDE registers 20,000 online consultations a year in Buenos Aires and its suburbs. In percentage terms this is low, considering the firm's 8,000-14,000 consultations daily. But that's also because remote consultations exclude advanced medical attention or emergencies. Remote consulting is used for simple cases like colds or digestive complaints.

For these, says Barbagallo, before the firm activates a home visit "which always has a two to three-hour margin" it first arranges a video-consultation so a doctor can begin to question the caller. "We've had good results," he says. The ACTRA president explains that in about 80% of cases, the problem is resolved just with a video consultation.

Video consultations have seen a significant increase but remote options are still a marginal.

Another company, the Galeno group, has an application called Llamando al Doctor (calling the doctor). The firm says the service began in November 2018 with 200 calls in the first month, gradually rising to more than 5,000 calls a month most recently, as patients have grown comfortable with the service. The Galeno group considers it a "very useful tool."

The firm Swiss Medical combines two types of attention, allowing patients to see the same doctor in person or online. "We studied it," the firm's medical director, Gabriel Novick, explains. "People tend to consult physicians in greater confidence if they have at least met the doctor at some point in the past. It's very different to having an unknown doctor from a call center."

Swiss Medical says that video consultations have seen a "significant increase" but that overall, remote options are still a "marginal" part of all medical consultations.

Some doctors and medical associations, however, question the use of remote consultations. Mauricio Eskinazi, head of Confemeco, a national forum of provincial medical councils, says that doctors do their best to avoid the practice. "We consider the medical act to be sacred," he says. "It's something that can only be provided between a doctor and a patient in person."

Virtually replaced? — Photo: Hush Naidoo

"In teleconsultations you avoid contact," Eskinazi adds. "The doctor-patient relationship doesn't develop appropriately. And there is no physical examination. There's no listening, touching, no way way of establishing a link."

The Association of Private Activity Physicians (AMAP) complains, furthermore, that remote medicine is making medical work "precarious." Its secretary-general, Héctor Garín, says doctors working as remote consultants are qualified as self-employed, taxed through the simplified scheme for independent workers, and "earn less than if they were in formal employment, with holidays, a salary and sick leave."

The only benefit of teleconsultations, he says, is for the private healthcare firms, which save money. "They're commercial entities meant to make money," Garín explains. "They're businesses."

Barbagallo, for his part, notes that the doctor's fee is the same regardless of whether the consultation is done in person or virtually. "What might go down is transport and transfer costs," he says. And in terms of access, the ACTRA head adds, teleconsultations can actually improve things. "The patient has more access if he or she lives in a remote area, and quicker access."

And the patients themselves? What do they think?

Lorena Gutierrez, who lives in the Retiro district in Buenos Aires and called in about a stomach problem, can vouch for the convenience factor. "They sent me a link and I downloaded an app," she says. "I waited a few minutes and a female doctor appeared. She was friendly and explained I had to keep resting, and drink water and an isotonic drink. She diagnosed gastroenteritis. I disconnected, and two minutes later I had an email with a certificate and reimbursement instructions in case I bought an antacid."

We consider the medical act to be sacred.

But she says that afterwards she felt uncomfortable with the situation. "The doctor would normally listen to your stomach for noises, look at your face and eyes," Gutierrez explains. "Thinking about it later, I was embarrassed. So no, I wouldn't use the service again."

Remote consulting is relatively new in Argentina compared to other countries. The U.S. journal Annals of Internal Medicine recently cited a study on 1,274 primary attention patients in California. Roughly 90% of the respondents said that teleconsulting had met their needs, that the doctor in question knew their histories and that the attention they received was good. Still, 41% of the study group said they prefer a proper doctor's visit.

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Future

7 Ways The Pandemic May Change The Airline Industry For Good

Will flying be greener? More comfortable? Less frequent? As the world eyes a post-COVID reality, we look at ways the airline industry has been changing through a pandemic that has devastated air travel.

Ready for (a different kind of) takeoff?

Carl-Johan Karlsson

It's hard to overstate the damage the pandemic has had on the airline industry, with global revenues dropping by 40% in 2020 and dozens of airlines around the world filing for bankruptcy. One moment last year when the gravity became particularly apparent was when Asian carriers (in countries with low COVID-19 rates) began offering "flights to nowhere" — starting and ending at the same airport as a way to earn some cash from would-be travelers who missed the in-flight experience.

More than a year later today, experts believe that air traffic won't return to normal levels until 2024.


But beyond the financial woes, the unprecedented slowdown in air travel may bring some silver linings as key aspects of the industry are bound to change once back in full spin, with some longer-term effects on aviation already emerging. Here are some major transformations to expect in the coming years:

Cleaner aviation fuel

The U.S. administration of President Joe Biden and the airline industry recently agreed to the ambitious goal of replacing all jet fuel with sustainable alternatives by 2050. Already in a decade, the U.S. aims to produce three billion gallons of sustainable fuel — about one-tenth of current total use — from waste, plants and other organic matter.

While greening the world's road transport has long been at the top of the climate agenda, aviation is not even included under the Paris Agreement. But with air travel responsible for roughly 12% of all CO2 emissions from transport, and stricter international regulation on the horizon, the industry is increasingly seeking sustainable alternatives to petroleum-based fuel.

Fees imposed on the airline industry should be funneled into a climate fund.

In Germany, state broadcaster Deutsche Welle reports that the world's first factory producing CO2-neutral kerosene recently started operations in the town of Wertle, in Lower Saxony. The plant, for which Lufthansa is set to become the pilot customer, will produce CO2-neutral kerosene through a circular production cycle incorporating sustainable and green energy sources and raw materials. Energy is supplied through wind turbines from the surrounding area, while the fuel's main ingredients are water and waste-generated CO2 coming from a nearby biogas plant.

Farther north, Norwegian Air Shuttle has recently submitted a recommendation to the government that fees imposed on the airline industry should be funneled into a climate fund aimed at developing cleaner aviation fuel, according to Norwegian news site E24. The airline also suggested that the government significantly reduce the tax burden on the industry over a longer period to allow airlines to recover from the pandemic.

Black-and-white photo of an ariplane shot from below flying across the sky and leaving condensation trails

High-flying ambitions for the sector

Joel & Jasmin Førestbird

Hydrogen and electrification

Some airline manufacturers are betting on hydrogen, with research suggesting that the abundant resource has the potential to match the flight distances and payload of a current fossil-fuel aircraft. If derived from renewable resources like sun and wind power, hydrogen — with an energy-density almost three times that of gasoline or diesel — could work as a fully sustainable aviation fuel that emits only water.

One example comes out of California, where fuel-cell specialist HyPoint has entered a partnership with Pennsylvania-based Piasecki Aircraft Corporation to manufacture 650-kilowatt hydrogen fuel cell systems for aircrafts. According to HyPoint, the system — scheduled for commercial availability product by 2025 — will have four times the energy density of existing lithium-ion batteries and double the specific power of existing hydrogen fuel-cell systems.

Meanwhile, Rolls-Royce is looking to smash the speed record of electrical flights with a newly designed 23-foot-long model. Christened the Spirit of Innovation, the small plane took off for the first time earlier this month and successfully managed a 15-minute long test flight. However, the company has announced plans to fly the machine faster than 300 mph (480 km/h) before the year is out, and also to sell similar propulsion systems to companies developing electrical air taxis or small commuter planes.

New aircraft designs

Airlines are also upgrading aircraft design to become more eco-friendly. Air France just received its first upgrade of a single-aisle, medium-haul aircraft in 33 years. Fleet director Nicolas Bertrand told French daily Les Echos that the new A220 — that will replace the old A320 model — will reduce operating costs by 10%, fuel consumption and CO2 emissions by 20% and noise footprint by 34%.

International first class will be very nearly a thing of the past.

The pandemic has also ushered in a new era of consumer demand where privacy and personal space is put above luxury. The retirement of older aircraft caused by COVID-19 means that international first class — already in steady decline over the last decades — will be very nearly a thing of the past. Instead, airplane manufacturers around the world (including Delta, China Eastern, JetBlue, British Airways and Shanghai Airlines) are betting on a new generation of super-business minisuites where passengers have a privacy door. The idea, which was introduced by Qatar Airways in 2017, is to offer more personal space than in regular business class but without the lavishness of first class.

Aerial view of Rome's Fiumicino airport

Aerial view of Rome's Fiumicino airport

commons.wikimedia.org

Hygiene rankings  

Rome's Fiumicino Airport has become the first in the world to earn "the COVID-19 5-Star Airport Rating" from Skytrax, an international airline and airport review and ranking site, Italian daily La Repubblica reports. Skytrax, which publishes a yearly annual ranking of the world's best airports and issues the World Airport Awards, this year created a second list to specifically call out airports with the best health and hygiene standards.

Smoother check-in

​The pandemic has also accelerated the shift towards contactless traveling, with more airports harnessing the power of biometrics — such as facial recognition or fever screening — to reduce touchpoints and human contact. Similar technology can also be used to more efficiently scan physical objects, such as explosive detection. Ultimately, passengers will be able to "check-in" and go through a security screening anywhere at the airports, removing queues and bottlenecks.

Data privacy issues

​However, as pointed out in Canadian publication The Lawyer's Daily, increased use of AI and biometrics also means increased privacy concerns. For example, health and hygiene measures like digital vaccine passports also mean that airports can collect data on who has been vaccinated and the type of vaccine used.

Photo of planes at Auckland airport, New Zealand

Auckland Airport, New Zealand

Douglas Bagg

The billion-dollar question: Will we fly less?

At the end of the day, even with all these (mostly positive) changes that we've seen take shape over the past 18 months, the industry faces major uncertainty about whether air travel will ever return to the pre-COVID levels. Not only are people wary about being in crowded and closed airplanes, but the worth of long-distance business travel in particular is being questioned as many have seen that meetings can function remotely, via Zoom and other online apps.

Trying to forecast the future, experts point to the years following the 9/11 terrorist attacks as at least a partial blueprint for what a recovery might look like in the years ahead. Twenty years ago, as passenger enthusiasm for flying waned amid security fears following the attacks, airlines were forced to cancel flights and put planes into storage.

40% of Swedes intend to travel less

According to McKinsey, leisure trips and visits to family and friends rebounded faster than business flights, which took four years to return to pre-crisis levels in the UK. This time too, business travel is expected to lag, with the consulting firm estimating only 80% recovery of pre-pandemic levels by 2024.

But the COVID-19 crisis also came at a time when passengers were already rethinking their travel habits due to climate concerns, while worldwide lockdowns have ushered in a new era of remote working. In Sweden, a survey by the country's largest research company shows that 40% of the population intend to travel less even after the pandemic ends. Similarly in the UK, nearly 60% of adults said during the spring they intended to fly less after being vaccinated against COVID-19 — with climate change cited as a top reason for people wanting to reduce their number of flights, according to research by the University of Bristol.

At the same time, major companies are increasingly forced to face the music of the environmental movement, with several corporations rolling out climate targets over the last few years. Today, five of the 10 biggest buyers of corporate air travel in the US are technology companies: Amazon, IBM, Google, Apple and Microsoft, according to Taipei Times, all of which have set individual targets for environmental stewardship. As such, the era of flying across the Atlantic for a two-hour executive meeting is likely in its dying days.

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