JMIR Publications

ABSTRACT

Background:

Internet hospital consultations are emerging in China as a new channel for patients to access healthcare services. Different from consultations offered by third party healthcare platforms like Haodf, Teladoc Health and MDLive, internet hospitals can integrate patients’ offline medical records, offering a seamless online-offline healthcare experience. Such integration has the potential to facilitate continuous healthcare management and lead to an increase in outpatient visits. However, it might also enhance the capability of online consultation services, potentially reducing the face-to-face visits. Given that patients in China can freely choose which hospital to visit, it is imperative for hospitals to understand the impact of this new health information technology on patients’ outpatient visits.

Objective:

This paper aims to analyze the impact of patients’ adoption of internet hospital consultations on their outpatient frequency and expenses, and whether this impact differs among urban and rural patients.

Methods:

The data used in this study was collected from a public tertiary hospital situated in a southeastern county of China. The dataset consists of three components: internet hospital consultation records (January 2021 to October 2022), offline outpatient records (January 2020 to October 2022), and patient demographics. To examine the causal effect, we employed a quasi-experimental design that combines the difference-in-differences (DiD) analysis with the propensity score matching (PSM). After performing PSM, a total of 2,065 pairs of patients (4,130 patients) were obtained for data analysis.

Results:

We have three main findings. Firstly, our results reveal that patients’ adoption of internet hospital consultations increases their frequency of outpatient visits by 2.4% per month (P<.001), and increases the expense of outpatient visits by 15.5% per month (P<.001). Secondly, the positive effect of internet hospital consultations on outpatient visits is more pronounced for patients residing in rural areas. Specifically, for every 1% increase in the distance between patients’ residences and the county government (located in urban area), the positive effect increases by 0.3% on monthly outpatient visits (P=.06), and increases by 2.4% on monthly outpatient expenses (P=.03). Thirdly, our post-hoc analysis shows that patients living in rural areas with higher healthcare quality would experience a mitigated positive effect of internet hospital consultations, compared to those living in rural areas with lower healthcare quality (P=.07).

Conclusions:

This study investigates the causal effect of patients’ adoption of internet hospital consultations on their outpatient visits. The results show that internet hospital consultations can bring positive effect to hospitals, by increasing both the frequency and expenses of outpatient visits. We further demonstrate that this positive effect varies with patients’ urban-rural status and their local healthcare quality. These findings provide insights for multiple stakeholders in the healthcare context.