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News, Research and Events from Rice University's Baker Institute for Public Policy
Baker Institute Update: Telemedicine in schools, Saudi Arabia's oil strategy
October 21, 2015: In this edition Five questions: Telemedicine in schools

The upcoming Oct. 30 event, “Telemedicine in Schools: Improving Access to Health Care,” will focus on the benefits of using telemedicine, or medical visits conducted remotely via video conferences, in school settings in order to improve students’ health and access to care. Health policy scholar Quianta Moore, whose research focuses on improving health outcomes for school-aged children, answers five critical questions about this emerging health care option.
 
How would utilizing telemedicine in schools impact the overall health care of students, particularly low-income children?


 
There are three main barriers to health care access for low-income families: 1) lack of health insurance, 2) inadequate access to services and 3) unaffordable costs. School-based health centers (SBHC) were developed as a way to overcome the barrier of access for vulnerable children. Improving access to medical services in school improves management of chronic diseases, such as asthma, and reduces emergency room utilization. SHBCs have also reduced health-related absences, which can improve the academic performance of at-risk children. Due to costs, however, many SBHCs operate with part-time physicians or nurse practitioners who are not present at the school every day. Telemedicine is a mechanism by which medical services can be provided to more children with the same number of physicians or nurse practitioners. Providers can remain in one location, which reduces travel time between schools, and treat patients from multiple schools. Moreover, telemedicine enables children to access specialists while at school. Increased access for children who would otherwise not go to the doctor regularly provides an overall health benefit to this population.

What would take place during a telemedicine exam?



A telemedicine encounter would be very similar to an in-person encounter, except the person performing the physical exam would not be the doctor, but rather the school nurse who follows the doctor’s instructions. For instance, if a child had a sore throat and needed to see a physician, the school nurse would initiate a telemedicine encounter. The physician would ask the student to open his or her mouth, just as he or she would in an in-person exam, then the nurse would place the otoscope in the student’s mouth to visualize the back of the throat. The physician would see the image in real time and then ask the nurse to swab the throat, if necessary. Prescriptions and labs are ordered electronically at most physician offices, therefore that part of the encounter would remain unchanged.
 
Are there drawbacks to using telemedicine that could affect a physician's ability to properly diagnose medical issues?
 
Telemedicine providers must conform to a standard of care that is applicable and equivalent to the expected in-person care, based on the patient’s age and presenting condition. The Texas Medical Board asserted concerns in their recent ruling about physicians prescribing medications via telephone, without ever seeing the patient.  Those concerns are valid; however, the telemedicine models used in schools encourage the establishment of a physician-patient relationship and utilize visual technologies that allow the physician to see and communicate directly with the patient. Studies assessing the reliability of a telemedicine physical exam showed similar reliability to an in-person exam when the clinician utilized the telemedicine equipment properly. Therefore, training medical personnel to use telemedicine equipment properly is an important component of ensuring the delivery of high quality care via telemedicine.

What are the barriers to implementing a telemedicine program, and have any Texas schools attempted to launch a pilot initiative?


 
Although there is evidence that telemedicine reduces costs long-term, the initial start-up costs of purchasing the telemedicine equipment and IT capabilities can be a barrier for smaller school districts to adopt a telemedicine program. There are a few schools in Houston as well as several rural schools who have adopted a telemedicine health service model.

HB 1878 permits Medicaid reimbursement for physicians who provide telemedicine services in schools. How will that affect the number of doctors and/or schools who may adopt telemedicine?
 
That is a very good question, one that I think only time can answer. The number of children enrolled in Medicaid varies at each school, and schools do not typically collect health insurance data. Therefore, a school would have to survey families to find out whether they had enough students enrolled in Medicaid to warrant partnering with a physician to deliver telemedicine services. It also presents a challenge for the school and the provider on how to treat students who are not enrolled in Medicaid or whose insurance may not reimburse for telemedicine encounters.

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Roundtable Dialogue: Saudi Arabia and the oil bust



The latest Roundtable Dialogue offered an in-depth look at the impact of Saudi Arabia’s decision to maintain high crude oil production levels amid a global oil price slump.
 
About 20 Roundtable members gathered for breakfast and policy analysis with Jim Krane, the Wallace S. Wilson Fellow for Energy Studies. Krane’s presentation, “The 2015 Oil Bust and Saudi Arabia’s Market Strategy,” focused on deciphering the Saudis’ actions, given that a rise in global supply and weak demand have pushed oil prices below $50 a barrel.
 
Since Saudi Arabia cut production in response to four oil busts since 1974, its approach this time around might seem counterintuitive, Krane said. However, “it’s not really unheard of or even illogical in the context of the circumstances.”
 
“The $100/barrel prices were bringing so much new oil online, so that a Saudi cut in production would have been akin to falling on your sword,” he explained. “It would have been propping up prices for higher-cost competition, which makes no sense. By maintaining their production, the Saudis would be defending their market share, as well as discouraging investment in competing supply.”
 
Krane noted that some U.S. observers view the Saudis’ strategy as an attempt to counter shale oil exports by the United States. Saudi Arabia is the largest crude oil exporter in the world, exporting 7.2 million barrels/day and accounting for about 10 percent of the global supply.
 
“Neither OPEC nor Saudi Arabia itself is in a position to supply the entire oil market,” Krane said. “They need outside suppliers. They just don’t want to compete with them for market share. There’s no hostile intent that I see. They basically had to act and had to discourage further investment in new oil supply, whether in the United States or elsewhere.”
 
Krane’s presentation is part of a Roundtable Dialogue series that most recently covered the Iran nuclear deal and stem cell policy. The gatherings are offered exclusively to Roundtable members throughout the year and focus on key domestic and global policy issues.
 
“They’re intended to provide an opportunity, in a small group setting, to gain a deeper understanding of the work done at the Baker Institute and to have conversations with the fellows about their research,” said Vince McElligott, executive director of development.
 
Roundtable Dialogues are one of many benefits that members enjoy, along with free admission to ticketed events, free event parking and other opportunities not available to the public. For more information about joining the Roundtable, contact Starr Dickerson at 713.348.8087 or starrd@rice.edu.
 
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Q&A: Roundtable Young Professionals

As part of an ongoing series of Q&As with Roundtable Young Professionals, David Diamonon — a finance and business development executive — talks about why he joined a young professionals group at the Baker Institute.

What drew you to the Baker Institute and the Roundtable Young Professionals?

I’m a native Houstonian, but I spent the last seven-plus years in Moscow, Russia and Kiev, Ukraine. When I returned to Houston, I knew I wanted to remain involved in international affairs. I appreciate the institute’s attention to Russia and Ukraine. I attended a panel discussion featuring Bonner Means Baker Fellow Joe Barnes that I just happened to find on the institute’s website the day before, and decided to join after that.

How does your RYP membership benefit you in regard to your job/career?  

It keeps me involved in things that are internationally focused. Knowing I wanted to settle down in Houston after all my time abroad, I’ve counted on future work having a more domestic focus. Even so, international affairs and markets only continue to be more intertwined with our own, so I knew that joining the Baker Institute would be the ideal way to stay in the loop on critical public policy and international issues.

What has been your favorite program/event at the Baker Institute?

The first event I attended, which was the 2014 panel featuring Barnes that focused on Russia and Ukraine. We had different perspectives, but that contrast was what made the discussion interesting. Having lived in that part of the world, I appreciated hearing firsthand other opinions on the political crisis in Ukraine.

What do you feel is the number one policy issue of our time in the United States?

In light of recent events in the Ukraine and now in Syria, U.S. policy towards Russia needs much more attention. Like any lumbering bureaucracy, the U.S. government has been slow to react to changing priorities, particularly in foreign affairs. While the Middle East and the war on terror have been and continue to be top priorities, emerging (or re-emerging) threats, such as an illegally expansionist Russia with Vladimir Putin at the helm, demand resolution.

What makes Houston such a great place for young professionals?

It has amazing growth potential. Even in this economic downturn, Houston will always be the energy capital of the world. The cost of living is still affordable compared to other peer cities. Houston is a real and attractive alternative for young professionals looking to build a career and a life, and it’s been a wonderful place to raise my family.

For more information on the Roundtable Young Professionals please visit http://bakerinstitute.org/roundtable-young-professionals/.

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Upcoming Events
  • National Health Care Reform: The Anniversary Edition. Five of the nation's leading health economists will discuss the impact of the Affordable Care Act and the challenges facing the Medicare and Medicaid programs. 8:00 am October 23
  • Roundtable Tailgate and Football Game. To celebrate the start of fall, the Baker Institute, the Jones Graduate School of Business and the Rice University Master of Global Affairs program invite you to Rice Families weekend for our first-ever tailgate and football game. 9:00 am October 24
  • Telemedicine in Schools: Improving Access to Health Care. This event will highlight the challenges in advancing policies that support telemedicine programs in Texas, and discuss innovative telemedicine programs around the state. The featured speaker, Texas state Rep. Jodie Laubenberg, authored a new law that allows Medicaid reimbursement for physicians who provide telemedicine support services in schools. Noon October 30
  • Whither Political Islam? Muslim Brotherhood and the AKP, Post-Arab Spring. Since 2010, much has changed for Islamists in the Middle East. This event will address the factors driving the changes and examine how the Arab Spring has shaped the dynamics of Islamist politics in the region. 6:00 pm November 4
  • The Arctic: A New Energy Frontier. The Arctic is widely regarded as the last frontier for global oil and gas resource development. This conference addresses the risks, opportunities and geopolitical and environmental stakes of this energy frontier. 8:30 am November 12
  • Creating a Campus Culture Where Every STEM Student Graduates. Collaborative partnerships to improve student success in science, technology, engineering and math (STEM) should operate under the expectation that every student will graduate. At this lecture, Senior Vice Provost David Laude will discuss efforts and tools to create such an environment at The University of Texas at Austin. 5:30 pm November 18
  • Egyptian Liberals at a Crossroad. This lecture will offer an overview of the state of liberalism in Egypt and what it portends for the country’s future. Amr Hamzawy, a visiting scholar at the Center on Democracy, Development, and the Rule of Law at Stanford University and a former member Egypt’s parliament, is the guest speaker. 6:30 pm December 3
  • Women in STEM in the Middle East and North Africa. This event seeks to identify and address the structural and cultural barriers preventing the entry and advancement of the region's women in the fields of science, technology, engineering and math (STEM). It also aims to promote a dialogue between stakeholders from academia, policymaking and industry to determine successful approaches to increasing the representation of women in STEM disciplines. Her Excellency Sheikha Lubna Bint Khalid Al Qasimi, the Minister of International Cooperation and Development for the United Arab Emirates, will be the keynote speaker. 8:30 am December 7

For a complete list, visit our event page.

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Rice University's Baker Institute for Public Policy is a nonpartisan, independent think tank in Houston, Texas. The institute's fellows and scholars conduct research and collaborate with experts from academia, government, the media, business and private organizations on domestic and foreign policy issues with the goal of bridging the gap between the theory and practice of public policy.
 
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