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Clearly, every country has its own medical system. I do not know what the single source of legality tends to be, but I assume the government appoints a minister of health, and the minister of health somehow oversees who is allowed to practice medicine, how, and where, and who will be in charge of important topics like drug legality and medical ethics. Apparently, the World Health Organization has an international health standard that is “legally binding in 196 countries”. (here)

Does that mean it is legally possible to create an international telemedicine product (as in, as much of health services as possible, like talking to a doctor, or getting medicine delivered, fast through an app)? The company would provide the same service but adapt it to any medical regulations of each country. In fact, the company would mainly be a vendor of a medium between doctors and patients already existing and practicing, in each country.

However, I guess my point was precisely that - internationalizing health care. In theory, in the global, digital times, it does not make that much sense that an American living in Germany could not get telemedicine from America with the same level of convenience - for example, German insurance covering it, and the American prescription being somewhat valid.

Maybe that is how things already are. People do sometimes have to travel for medical treatment and country’s medical systems do have to permit a degree of interoperability.

I guess the bottom line is that medicine is like any other sector, every country is its own authority and creates its own system, including law, business, education, etc.

What I’m trying to figure out is if that means it is already totally possible for an international telemedicine service which can connect you with a doctor in any country and give a prescription; but you would just need to figure out how to use that diagnosis in your country.

My conclusion is I think this is legal. Is there some aspect of this I don’t know about?

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    "Germany" is very interesting as an example because it's a federal state and also a member of the EU. Healthcare in particular is split over all layers: medicine approval is handled by the EU, and hospitals are run by the Bundesländer (the 16 German states).
    – MSalters
    Nov 14, 2022 at 15:50
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    Given how laisée faire America is when it comes to handing out opioids and antibiotics, it makes a whole lot of sense to prevent them from being able to prescribe medicine in more sensible countries... Nov 14, 2022 at 16:10
  • In addition to the many good answers (but that's a bit too short for a real answer), there's the issue of language, that of timezones, possible culture-specific issues (such as male doctors seeing female patients and vice-versa), area-specific issues (some diseases are eradicated in some countries while prevalent in others)...
    – jcaron
    Nov 14, 2022 at 17:14

6 Answers 6

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The WHO regulations (according to that page; I haven't seen them) "provide an overarching legal framework that defines countries’ rights and obligations in handling public health events and emergencies that have the potential to cross borders." They don't dictate the conditions for practicing medicine.

it does not make that much sense that an American living in Germany could not get telemedicine from America with the same level of convenience - for example, German insurance covering it, and the American prescription being somewhat valid.

This would result in a geometric increase in the administrative burden. You need a system for the American prescriber to know what medicines are approved in both countries (and in every other covered country). You need some way for the German health authorities and the insurers to trust that prescribers in the United States are not endangering the health of people in Germany, which means that they need to evaluate the education and certification systems in place in the US (and every other covered country). You need to consider the legal recourse in cases of malpractice: if the prescriber makes a mistake, does the case go to the US courts or German? If German, will the US state that licensed the prescriber honor a judgment revoking the prescriber's medical license? And more.

There are simply too many elements that need to be coordinated. With two countries, you have to reconcile one pair of systems. With three countries, three pairs. With four countries, six pairs. With N countries, it's N(N-1)/2, so even with a modest number of countries such as 20, you have 190 pairs of systems to consider. With 196, the number is 19,110. Subnational jurisdictions increase the number even farther; if you count each US state separately, you have 245 "countries," leading to 29,890 "pairs"; divisions in other countries would also be relevant.

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    Even in just the USA, most telemedicine companies only cover a handful of states each because each and every state has a completely different set of bureaucracy. Most states also require that the doctors seeing patients in their state also have a license in their state and ~20h annual training in their state. To get that annual training in all ~53 territories would be ~27 days a year in just training to maintain the licenses. I'm probably overstating it, but very few organizations have pulled this off even usa-wide. Nov 14, 2022 at 16:14
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    Not only "know what medicines are approved", but also what they are approved for, what names they have, what forms they take, what quantities are available, etc.
    – jcaron
    Nov 14, 2022 at 17:09
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    @MooingDuck No--the licenses require annual training but it doesn't need to be in the state. Plenty of subspecialties don't have enough practitioners to make a class in every state practical. Nov 15, 2022 at 5:43
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    "an exponential increase in the administrative burden" - nope. You have it right there: N(N-1)/2, that is a square function, not exponential. My pet peeve. Besides, there are solutions for this problem, which is essentially the same as managing the administrative burden of having X health care providers and Y insurers within one country. I.e. you'd need an international entity that defines sufficiently detailed standards of care and prices, payments and liabilities, so that each provider and insurer can individually work with these standards and be compatible with the others. Nov 15, 2022 at 13:05
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    @MichaelBorgwardt I mean, you're correct of course, but the OP is clearly using "exponential" colloquially: many many more people are familiar with that term than "quadratic". Don't you think that's being just a bit pedantic? Things like that irritate me too, but I swallow it for casual conversation, even conversation with other technical people. Nov 15, 2022 at 13:23
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It is not, generally, legal. Each locations has one or more government empowered bodies that set the rules for who can practice medicine under what circumstances with what constraints, within their borders.

What medications can be prescribed by whom and fulfilled by whom are also regulated.

In the US, at least, COVID has made it clear that states need to modify policies to accelerate telemedicine across borders but it is not in place in the US and certainly not worldwide.

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Suppose you have US based doctors licensed under US laws offering consultations via video to people in Germany.

First there are no legal restrictions on talking about medical issues. But the moment you try to either record the video or write down some of the things talked about you would run into data protection laws. As this is medical data this will be delicate and complicated.

If you want your doctors in the US to be paid from German health insurers you would have to go through the German regulations on what is or isn't covered. There are some fairly recent laws that allow video consultations in principle but they assume that a) you need a real-live doctor-patient contact before and b) the doctor is a licensed doctor in Germany. So this is practically impossible to fullfill for your service.

Finally you want your doctors to be able to write prescriptions that would be valid in a German pharmacy. Again there are laws currently being introduced that allow purely digital prescriptions (it is still in trial phase). However again you need to be a licensed German doctor to use that, so your service wouldn't be able to do that.

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    Data Protection laws are absolutely not a hindrance, and more of a red herring in this discussion. Just like you can use google just fine from Germany.
    – Hobbamok
    Nov 15, 2022 at 9:41
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    @Hobbamok: Are you saying that the GDPR is no hindrance? Given the Schrems lawsuits? And when the data specifically is medical data, which is more protected than your typical Facebook status?
    – MSalters
    Nov 15, 2022 at 10:03
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Doctors must be licenced where they practice

A German doctor is not (normally) licenced to practice medicine in the USA. If they consult with an American resident who is located in the USA they are practising in the USA and are breaking the law. If they consult with a German resident temporarily in the USA, they might not be practicing in the USA and might be OK.

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    People who are not licensed professionals would generally be forbidden from accepting payment for medical advice or judgments, or from having their judgments honored by other professionals (e.g. pharmacists), but I don't think there would generally be any law against anyone who was asked "Do you think the itchy spot on my back looks serious" from offering a layperson's judgment. If someone in Maine uses a Germany-based web site to pay a doctor in Germany for advice, and the doctor doesn't issue any prescriptions, from the point of view of Maine I think that would be equivalent to...
    – supercat
    Nov 15, 2022 at 16:18
  • ...soliciting a layperson's advice from any other kind of unlicensed professional.
    – supercat
    Nov 15, 2022 at 16:18
  • @supercat the assumption in your first sentence is wrong - giving medical advice as a layperson is practicing medicine without a licence irrespective of payment
    – Dale M
    Nov 15, 2022 at 20:28
  • My intended point, which I failed to really express, was that the act of giving advice to someone who happens to be in a particular place does not necessarily constitute practicing medicine in that place. A better example would have been a patient of a doctor in Texas who has a reaction to a drug while visiting Maine, and calls his doctor in Texas for advice. I can't imagine the state of Maine saying that such an action would constitute "practicing medicine in Maine" and would only be legal if the person's doctor was licensed to practice in Maine as well as Texas.
    – supercat
    Nov 15, 2022 at 20:52
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    @Dale M The assertion in your comment is wrong. None of the national or state jurisdictions with which I am familiar restrict 'giving medical advice' except as an additional restriction on licensed professionals. There are other restrictions (surgery, representation, prescribing etc) that apply to the general public, but they are all strictly defined.
    – david
    Nov 16, 2022 at 1:38
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Although it would be possible for a 'person' in country A to offer 'advice' to a patient in country B, that would only be legal if it was clear at all times that the 'person' offering advice was not a 'doctor'.

Because representing that you are 'doctor' in a place where you are not licensed is illegal. (Or allowing others to represent, or permitting the patient to think that, or ....)

This would generally place the 'person' at risk in both countries: the country of licensure, and the other country. Both countries would take an identical view of practicing where unlicensed.

It's not that difficult for a Doctor with whom you have an existing relationship. Doctors are used to being careful about the kind of advice they give in the kind of circumstances which apply. Including saying things like: "That sounds like you need to see a Doctor"

But international medical services deal with this situation by having appropriately licensed doctors for consultation and referral

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In the future: Liability

Right now, it's basically illegal due to the whole lot of bureaucracy the other questions mention already. Most of these answers boil down to: "It's not legal by default, it has to be somewhat explicitly allowed". And that IMHO won't happen for a while, because of the issue of liability and edge cases.

How do you get damages from a Doctor from B, if what he did was a treatment with an accepted risk in country B which your country A does not allow because of that known risk? Is the doctor liable? Is he not? The thing is, even IF politicians were motivated to tackle this issue, it is such a highly complex issue that we won't see it in the near future, despite the technological feasability being there.

MAYBE we see telemed services on a 100% private basis from developed nations (the doctor) to developing nations (the rich patients there). Because legal issues are less relevant and the money would be there.

However: As some said, not even within the US, which almost everyone sees as one country you can offer broad telemed services due to bureaucracy. [Though I wouldn't be surprised if literally the entire rest of the world would get it together before the squabble of US states does]

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