The Willingness to Pay for Telemedicine Among Patients With Chronic Diseases: Systematic Review

The Impact of Introducing a Temporary Telemedicine Policy on Primary Care Visits: An Analysis of National Claims Data in South Korea

Background: This study evaluates the impact of temporary telemedicine implementation on primary care visits, which surged during the COVID-19 pandemic in South Korea. Methods: This study was conducted using national claims data from February 24, 2020 to February 23, 2021. The study included 1,926,300 patients with acute mild respiratory diseases and 1,031,174 patients with acute mild gastrointestinal diseases. The study compared medication prescriptions, follow-up visit patterns, and safety outcomes, including admissions to emergency departments (EDs), general wards (GWs), and intensive care units (ICUs), between telemedicine and in-person visits. Results: Telemedicine was linked to higher medication prescription rates for both respiratory and gastrointestinal conditions, higher levels of antibiotics use, and longer prescription durations. Patients who had an initial telemedicine consultation were more likely to have an in-person follow-up visit within 1 day. Conversely, those with an initial in-person visit were more inclined to use telemedicine for their early second visit within 1 day. There were no significant differences in ED or ICU admissions, except for a slight increase in GW admissions for gastrointestinal conditions. Conclusion: Telemedicine can effectively complement in-person care for acute mild conditions without compromising patient safety, suggesting its potential for broader integration into primary care. Further studies are recommended to optimize telemedicine use and address any long-term impacts on health care delivery.

Acceptance and Willingness-to-Pay for Teledentistry: A Contingent Valuation Study

OBJECTIVES

The study sought to assess patients' acceptance of teledentistry and their willingness-to-pay (WTP) for teledentistry.

METHODS

Patients attending a dental appointment at a public hospital in Singapore were recruited to participate in a cross-sectional study between August 2021 and March 2023. Patients' acceptance of video consults and reviews were compared using McNemar tests. A bidding game contingent valuation method with random starting points was adopted to elicit participants' WTP for teledentistry. Logistic regression was carried out to assess participants' WTP equivalent in-person costs by sociodemographic factors.

RESULTS

Out of 597 respondents, the proportion willing to have an initial consult via a video call was 54.4% and 70.9% for a video review. Teledentistry acceptance was lower among older age groups and higher among those with higher education levels (adjusted odds ratio [adj. OR] 3.63, 95% CI = 2.16-6.15 for video reviews for university graduates). The proportion of participants willing to pay at least the quantum of in-person care for video consults and reviews was 15.2% and 79.6%, respectively. Compared to those aged 21 to 30 years, the WTP for video reviews was lower among those aged 41 years and above (OR: 0.39, 95% CI = 0.20-0.72).

CONCLUSIONS

Majority of patients were willing to undergo and pay at least in-person costs for video reviews compared to video consults. Younger age and higher education levels were associated with a higher willingness to accept video consults and reviews, and a higher WTP at least the equivalent in-person costs for video reviews.

A choice based conjoint analysis of mobile healthcare application preferences among physicians, patients, and individuals

The rapid proliferation of healthcare service applications (apps) makes it challenging for consumers to determine the best one for their needs, prompting the Korean government to introduce an accreditation program to verify app safety. This study aims to identify the factors influencing the choice of healthcare service apps among physicians, patients with chronic diseases, and healthy individuals. We conducted a choice-based conjoint analysis with six factors (number of studies on effectiveness, frequency of information delivery, cybersecurity and data safety, user satisfaction, accreditation, and costs). 1,093 participants (407 healthy individuals, 589 patients, and 97 physicians) participated in the online survey. Across all groups, cybersecurity and data safety were the most important preference factors (healthy individuals: β = 2.127, 95% CI 2.096-2.338, patients: β = 1.569, 95% CI 1.481-1.658, physicians: β = 1.111, 95% CI 0.908-1.314). All groups were willing to pay more approximately $12 for high cybersecurity and data safety compared to low.

A realist review of factors critical for the implementation of eHealth in chronic disease management

BACKGROUND

In Canada, chronic disease is responsible for 88% of deaths and $120 billion in cost each year. With 44% of Canadian adults living with at least one chronic condition, only 66% receive necessary care. Ehealth interventions are instrumental in chronic disease management (CDM), especially since the pandemic, as they provide accessible, cost-effective solutions for self-management. Despite its promise and accelerated use, its implementation remains challenging. This paper reports on a realist review of critical factors for the implementation of eHealth interventions relevant to conditions such as heart failure, chronic obstructive pulmonary disease, chronic kidney disease, and diabetes. The findings are presented in terms of context, mechanisms, and outcomes.

METHODS

A realist review of the primary literature was conducted by searching five databases: Medline, Embase, Cochrane, CINALH and PsycInfo. The initial search was run for a date spanning from the databases' inception to September 2018 and subsequently updated to dates spanning from October 2018 to May 2022. A systematic and iterative approach to data extraction was used. Thematic analysis was used to identify context-mechanism-outcome (CMO) configurations.

RESULTS

Among the 13,209 citations retrieved, 64 articles were included. This paper reports the top ten configurations found to facilitate or hinder eHealth implementation. Key themes related to context, such as team-based care, and action, including program use, perceived usefulness and motivation, are reported.

CONCLUSIONS

This study explores the role of context, mechanisms, and outcomes in ehealth implementation, highlighting the nonlinear relationships between these factors. Future implications include empirical testing CMOs as middle-range theories in real-world settings to determine causality.

TRIAL REGISTRATION

The review protocol was registered with PROSPERO (CRD42020208275) on 1 October 2020.

Patient Preferences for Telerehabilitation Compared to In-Person Physiotherapy: A Binary Discrete Choice Experiment

OBJECTIVE

To investigate the key factors that influence patients' preferences for telerehabilitation consultations in comparison to traditional in-person physiotherapy consultations and explore how these factors vary across different patient demographic characteristics.

METHODS

A binary discrete choice experiment was conducted with 152 participants who had participated in physiotherapy. The primary outcome measures were the attributes related to telerehabilitation and in-person consultations, including appointment duration, cost, distance, purpose, therapist, time of day, and wait time. Participants' preferences were assessed based on their choices in the binary choice experiment.

RESULTS

The study did not identify any attributes of consultations that clearly influenced patients' preference for telerehabilitation versus in-person physiotherapy. There was a trend towards preferring telerehabilitation with decreased appointment wait times and lower monetary costs. Patient demographics revealed that individuals with a single chronic health condition were clearly less inclined towards telerehabilitation (OR = 0.5, 95% CI 0.27-0.93), as were those located in outer regional locations (OR = 0.34, 95% CI 0.12-0.99). Additionally, respondents preferring a short 5 km travel distance showed markedly lower preference for telerehabilitation (βTelerehab×Distance_5km = -0.94, 95% CI -4.34 to -0.51, p < 0.001).

CONCLUSION

To enable broader access to physiotherapy via telerehabilitation, clinicians, and policymakers should prioritize offering timely and cost-effective sessions. The results of this study can then inform the development of telerehabilitation offerings that are better matched to patient preferences.

Knowledge, Readiness, Willingness-to-Use, and Willingness-to-Pay for Telehealth in Nonlife-Threatening Emergency Department Visits

Background

The emergency department (ED) provides a significant portion of health care services in the United States, and its utilization has increased over the past decade. ED overcrowding remains a considerable challenge to many EDs. The objectives of this study were (1) to evaluate the knowledge of telehealth and readiness to use it among patients who visit EDs in a nonurgent triage category and (2) to estimate their willingness-to-use and willingness-to-pay for telehealth consultations.

Methods

A structured questionnaire was administered using a tablet to adult patients who visited the ED of a large medical center and who were triaged into a nonurgent category. Respondents were asked about their sociodemographic and ED visit characteristics and health and telehealth utilization history. Then, we presented them with a hypothetical scenario for visiting a board-certified ED doctor through telehealth instead of in-person visits, and, using a double-bound dichotomous choice iterative bidding algorithm, we solicited their willingness-to-pay for such a telehealth visit.

Results

A total of 171 patients agreed to participate in the study. More than half of the respondents (n = 107; 62.6%) said they have health insurance. Almost half of the respondents (n = 71; 41.5%) reported the main reason for going to the ED was an ongoing condition or concern. More than two-thirds of the respondents identified themselves as being very proficient with using a smartphone or tablet (n = 116; 67.8%), and only a few (n = 21; 12.3%) reported not having any internet-capable device. Most respondents (n = 148; 86.5%) had never heard about telehealth. However, after a brief description of telehealth, we found that approximately two-thirds of the patients would be willing to use or consider using telehealth (n = 107; 62.6%), and one-third (n = 64; 37.4%) would not be interested. We did not observe any statistically significant differences in willingness-to-use. However, we observed statistically significant differences in the willingness-to-pay $50 by gender (p < 0.01), by currently having a regular doctor/clinic (p < 0.05), and by health insurance status.

Conclusions

Hospitals should consider investigating telehealth services that can be provided to their communities as an option instead of visiting their EDs. While technology does not seem to be a barrier to telehealth, more educational initiatives to inform the public about telehealth are desirable. A targeted advertisement campaign to recommend telehealth for nonlife-threatening ED visits could be developed once more user characteristics are collected.

Telemedicine Integrated Care Versus In-Person Care Mode for Patients With Short Stature: Comprehensive Comparison of a Retrospective Cohort Study

BACKGROUND

Telemedicine has demonstrated efficacy as a supplement to traditional in-person care when treating certain diseases. Nevertheless, more investigation is needed to comprehensively assess its potential as an alternative to in-person care and its influence on access to care. The successful treatment of short stature relies on timely and regular intervention, particularly in rural and economically disadvantaged regions where the disease is more prevalent.

OBJECTIVE

This study evaluated the clinical outcomes, health-seeking behaviors, and cost of telemedicine integrated into care for children with short stature in China.

METHODS

Our study involved 1241 individuals diagnosed with short stature at the pediatric outpatient clinic of Peking University Third Hospital between 2012 and 2023. Patients were divided into in-person care (IPC; 1183 patients receiving only in-person care) and telemedicine integrated care (TIC; 58 patients receiving both in-person and virtual care) groups. For both groups, the initial 71.43% (average of 58 percentages, with each percentage representing the ratio of patients in the treatment group) of visits were categorized into the pretelemedicine phase. We used propensity score matching to select individuals with similar baseline conditions. We used 7 variables such as age, gender, and medical insurance for the 1:5 closest neighbor match. Eventually, 115 patients in the IPC group and 54 patients in the TIC group were selected. The primary clinical outcome was the change in the standard height percentage. Health-seeking behavior was described by visit intervals in the pre- and post-telemedicine phases. The cost analysis compared costs both between different groups and between different visit modalities of the TIC group in the post-telemedicine phase.

RESULTS

In terms of clinical effectiveness, we demonstrated that the increase in height among the TIC group (ΔzTIC=0.74) was more substantial than that for the IPC group (ΔzIPC=0.51, P=.01; paired t test), while no unfavorable changes in other endpoints such as BMI or insulin-like growth factor 1 (IGF-1) levels were observed. As for health-seeking behaviors, the results showed that, during the post-telemedicine phase, the IPC group had a visit interval of 71.08 (IQR 50.75-90.73) days, significantly longer than the prior period (51.25 [IQR 34.75-82.00] days, P<.001; U test), whereas the TIC group's visit interval remained unchanged. As for the cost per visit, there was no difference in the average cost per visit between the 2 groups nor between the pre- and post-telemedicine phases. During the post-telemedicine phase, within the TIC group, in-person visits had a higher average total cost, elevated medical and labor expenses, and greater medical cost compared with virtual visits.

CONCLUSIONS

We contend that the rise in medical visits facilitated by integrating telemedicine into care effectively restored the previously constrained number of medical visits to their usual levels, without increasing costs. Our research underscores that administering prompt treatment may enable physicians to seize a crucial treatment opportunity for children with short stature, thus attaining superior results.

Willingness to Pay for Telemedicine Services Among Uninsured Individuals in Saudi Arabia: A Cross-Sectional Survey

Purpose

This study aimed to explore the Willingness To Pay (WTP) of uninsured individuals in Saudi Arabia and the factors influencing their decisions regarding telemedicine services.

Patients and Methods

This study used a cross-sectional survey design and convenience sampling to gather data from respondents aged 18 years or older who had visited healthcare facilities at least once in the past year and were uninsured. WTP was determined using the contingent valuation method, and a two-part regression model was applied to analyze the factors influencing WTP.

Results

The study included 4232 participants and discovered that approximately 17.41% were willing to pay for telemedicine services. Those aged 60 and older, employed in the government or private sector, in higher socioeconomic quintiles, and experiencing chronic health issues showed a positive association with their WTP value. Conversely, individuals aged between 30 and 44 years, married, and unemployed exhibited a negative association with a lower WTP value.

Conclusion

The findings indicate that most respondents hesitated to pay for telemedicine services, with a significant influence from sociodemographic characteristics, underscoring the need to promote telemedicine use among underserved populations and address health disparities.

The demand for private telehealth services in low- and middle-income countries: Evidence from South Africa

In low- and middle-income countries, many believe that telehealth services could significantly expand access to doctors by offering remote access at low cost. Yet, despite its convenience, telehealth care is limited by the absence of physical examination, point-of-care testing, or immediate treatment. Hence it is unclear how individuals value such options compared to standard face-to-face care. We study this issue in South Africa with general practitioners who today mostly practice in the private sector and are geographically located in wealthier areas with higher health insurance coverage. We use an incentive-compatible method to elicit robust measures of willingness-to-pay (WTP) for telehealth and face-to-face consultations with general practitioners in a sample of uninsured individuals. We find that only 36% of respondents are willing to pay the prevailing market price for a telehealth consultation. We find average WTP for in-person consultations is only 10% higher than that of telehealth. Additionally, individuals with higher health needs are willing to pay a premium for face-to-face consultations, while others are indifferent. Our findings suggest that private telehealth services are better suited for more minor health needs, but are unlikely to expand access to a majority unless cheaper models are introduced.

ChatGPT vs. neurologists: a cross-sectional study investigating preference, satisfaction ratings and perceived empathy in responses among people living with multiple sclerosis

BACKGROUND

ChatGPT is an open-source natural language processing software that replies to users' queries. We conducted a cross-sectional study to assess people living with Multiple Sclerosis' (PwMS) preferences, satisfaction, and empathy toward two alternate responses to four frequently-asked questions, one authored by a group of neurologists, the other by ChatGPT.

METHODS

An online form was sent through digital communication platforms. PwMS were blind to the author of each response and were asked to express their preference for each alternate response to the four questions. The overall satisfaction was assessed using a Likert scale (1-5); the Consultation and Relational Empathy scale was employed to assess perceived empathy.

RESULTS

We included 1133 PwMS (age, 45.26 ± 11.50 years; females, 68.49%). ChatGPT's responses showed significantly higher empathy scores (Coeff = 1.38; 95% CI = 0.65, 2.11; p > z < 0.01), when compared with neurologists' responses. No association was found between ChatGPT' responses and mean satisfaction (Coeff = 0.03; 95% CI = - 0.01, 0.07; p = 0.157). College graduate, when compared with high school education responder, had significantly lower likelihood to prefer ChatGPT response (IRR = 0.87; 95% CI = 0.79, 0.95; p < 0.01).

CONCLUSIONS

ChatGPT-authored responses provided higher empathy than neurologists. Although AI holds potential, physicians should prepare to interact with increasingly digitized patients and guide them on responsible AI use. Future development should consider tailoring AIs' responses to individual characteristics. Within the progressive digitalization of the population, ChatGPT could emerge as a helpful support in healthcare management rather than an alternative.

Telehealth Consultation for Malaysian Citizens' Willingness to Pay Assessed by the Double-Bounded Dichotomous Choice Method

Background

Re-envisioning healthcare in technology tools includes robust utilisation of telehealth, improvement in access, quality, care efficiencies and cost-effectiveness of healthcare services. In reality, the technology's potential to transform healthcare may be limited by the ability to pay for it. This study aims to estimate Malaysian citizens' willingness to pay (WTP) for telehealth consultations and determine the factors contributing to it. This is vital to inform decision-making about expansion, preferences and deployment of a pricing strategy for telehealth services.

Methods

A random sample of 220 adult Malaysians was surveyed using social network services (SNS). Three different WTP bid arrays were identified and each respondent received a randomly drawn bid price. The WTP fee for using the telehealth consultation for 30 min was measured and estimated using a Double-Bounded Dichotomous Choice (DBDC) and the Random Utility Logit Model.

Result

The median WTP was estimated to be RM58 (JPY2,198), RM78 (JPY2,956) for 132 respondents' willingness to use telehealth consultation and RM26 (JPY985) for 51 respondents who were unwilling. Further analysis found that WTP is correlated with the perception and willingness of the respondents to use it.

Conclusion

Despite most respondents being willing to pay for telehealth consultations, sociodemographic characteristics and affordability influenced the process of making decisions about WTP for telehealth consultation. This finding suggests that the private sector can play a crucial role in the deployment of telehealth. However, there may be a need to consider affordability and how to increase access and use of telehealth services.

Online medical consultation in China: Demand-side analysis of obese patients' preferences and willingness-to-pay for online obesity consultations

Objective

With obesity a major health concern and call on healthcare resources in China, we explored the preferences and willingness to pay (WTP) for obesity OMC, including the influencing factors behind WTP and preferences.

Method

We recruited 400 obese participants to undertake a discrete choice experiment (DCE) and the contingent value method (CVM) survey. We used CVM to measure obese participants' WTP for one-click services (OCS) and used DCE to estimate obesity participants' preferences and WTP for OMC with different attributes.

Results

Obese participants were willing to pay more than RMB80 on average for OCS, and more than 50% of participants had a WTP over RMB50 and 5% had a WTP over RMB300, reflecting the strong willingness of Chinese obese patients to pay for OMC. Educational background, income, ethnicity, previous OMC experience and accessibility to offline hospitals with different levels impacted WTP. The relative importance score of attributes in descending order was cost, doctors' hospital level, doctors' level, online waiting time, consultation time and consultation form. Obese patients preferred lower cost, doctors from higher-level hospitals, doctors with higher expertise levels, shorter waiting time and consultation duration, and telephone consultation were preferred. 30-min waiting time, 15-min consultation duration and telephone consultation were the most economically efficient set we found.

Conclusion

To maximize health resources, provincial tertiary and municipal hospitals face different paths to developing obesity OMC platforms. We encouraged young doctors to use OMC. OMC regulators should implement consumer protection policies to optimize OMC pricing and address potential 'unfair' pricing.

Preferences and willingness-to-pay for a blood pressure telemonitoring program using a discrete choice experiment

This study aimed to elicit the preferences and willingness-to-pay for blood pressure (BP) telemonitoring programs. This study also investigated the different factors or participant characteristics that could influence preferences and choice behaviors. Participants with hypertension were identified from an online survey panel demographically representative of Singapore's general population. Participants completed a discrete choice experiment (DCE) with 12 choice sets, selecting their preferred BP monitoring program differing on five attributes: mode of consultation, BP machine type (with Bluetooth or not), BP machine price, monthly fee, and program duration. The base reference population (male, married, higher income, more formal education years, full-time worker, aged 55 to <65 years, and digital skills score of 36) preferred teleconsultation over in-person consultation, Bluetooth feature, lower machine price, lower monthly fee, and shorter program duration. A subgroup of participants can be considered teleconsultation-resistant, and three demographic factors were associated with lower preference for teleconsultation: female, fewer formal education years, and lower income. Considering the reference population and Bluetooth attribute, participants were willing to pay 66 SGD (~49 USD) additional for the machine to obtain the Bluetooth feature. Considering the reference population and teleconsultation attribute, participants were willing to pay 6.80 SGD (~5.10 USD) extra monthly fee for a program using teleconsultation. Here we report that amongst participants with hypertension, there is strong preference for the use of teleconsultation and a BP machine with Bluetooth feature in a BP monitoring program. However, a subgroup of participants are teleconsultation-resistant and would prefer in-person consultation.

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

BACKGROUND

Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products.

OBJECTIVE

In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals.

METHODS

A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis.

RESULTS

We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure.

CONCLUSIONS

The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics.

Determinants of and Willingness to Use and Pay for Digital Health Technologies Among the Urban Elderly in Hangzhou, China

Purpose

In recent years, little research has been conducted on the willingness to use and pay for digital health technologies for elderly people. Thus, this study investigates the willingness to use and pay for digital health technologies and their influential factors among urban elderly in Hangzhou, China.

Methods

A structured questionnaire was completed by 639 older adults from 12 communities in Hangzhou. This paper presents a descriptive statistics analysis and performs a multivariate regression to identify the determinants of willingness to use and pay for digital health technologies among the elderly.

Results

The result shows the percentage of participants who chose very willing (3.6%) and partly willing (10%) to use was lower than those who were less unwilling (26.4%) and not willing (27.1%) to use. The percentage of participants who are unwilling (less unwilling,30.5%; not willing, 39.7%) to pay for digital health technology is even higher. The regression results show that age, working status, exercise and physical activity, medical insurance, income, life satisfaction and history of illness were significantly associated with willingness to use digital health technology among urban elderly. On the other hand, age, exercise status, income and history of illness were significantly associated with willingness to pay for digital health technologies among older adults.

Conclusion

The overall willingness to use and pay for digital health technologies are low among urban older people living in Hangzhou. Our results have important implications for digital health policy making. Practitioner and regulator should develop strategies to improve the supply of digital health technology services to meet different demands of the elderly with different age, working status, exercise and physical activity, medical insurance, income, life satisfaction and history of illness. And medical insurance would be an important instrument to facilitate digital health development.