Access to Healthcare as a New Commons: Telemedicine as a Strategy for Providing Value-Based Healthcare Services in Rural Areas

Commons is a general term that refers to a resource shared by a group of people. Over the years, scholars have identified two generations of commons. The first generation of commons was about sharing of physical things; the second one is about intangible commons pool resources such as science and culture. These generally can be recognized as "rights" (Hess 2008). Among the various New Commons sectors there is medical and health. In the perspective of guaranteeing the right of Health, the ―Access to Healthcare‖ could be considered as a New Commons provided by worldwide National Healthcare Systems (NHS), However, healthcare sector is characterized by plenty of stakeholders with myriad, often, conflicting goals. The value-based approach (Porte, 2010) attempts to introduce a new universal language in healthcare management around the value for the patient that reconcile all stakeholders‘ interests. The goal of this approach is to improve the outcome and increase the number of treatments. This aim is very difficult to be enriched for rural residents; when patients live in remote areas, providing them with valuable medical care can be considered a hard challenge for the NHS, which has to be addressed also by the employment of new healthcare strategies and technologies. Defined as "a new healthcare delivery process provided when patient and professional are not physically in the same place" (Italian Ministry of Health, 2014), telemedicine could be seen as an answer to this challenge. Accordingly, this study aims at discovering if telemedicine employment can be effectively considered as a successful strategy to improve healthcare in location far from specialized hospital, enhancing the New Commons ―Access to care‖. A statistical-based narrative review of the literature was conducted in the field of telemedicine, with the aim to understand which experiences of telemedicine applications have got successful results as support of healthcare delivering in rural locations. With regards to rural and remote areas, several Authors recognized telemedicine-based strategies as a method to facilitate the access to healthcare in different medical disciplines. In particular, many studies highlight that telemedicine improves patient care by increasing the capacity of the rural clinician to manage patient locally, minimizing time away to support networks and reducing unnecessary transfers. Telemedicine could also be considered a cost-effective method whose outcomes remain similar (if not better) in quality to ―staffed‖ services, whose infrastructural costs could be easily paid-back.