Discrete choice experiment to measure consumer preference for the policy attributes of telehealth

Abstract

The healthcare delivery system in Korea has been led by a provider-centered and treatment-centered paradigm. But with the development of digital healthcare including telemedicine, this system is facing a transitional period. Overseas telemedicine has rapidly expanded since the COVID-19 pandemic. Physician-patient telemedicine is temporarily allowed in Korea during the ‘severe’ stage of COVID-19 (from February 2020 to present). Currently, the bill submitted to the National Assembly limits the service targets to patients with mobility difficulties and chronic diseases. In addition, the treatment is allowed only for the returning patients, and the main targets are clinic-level medical institutions. As the consumer choice becomes more and more important, a new doctor-patient relationship and new medical ethics are needed. Since the telemedicine is a service in which consumer sovereignty is reinforced with autonomous decision-making and information collection, it is necessary to understand the consumer’s preference in telemedicine. In order to discuss the introduction form of physician-patient telemedicine, estimation should be made on consumer (patient) utility and willingness to pay (WTP) according to the allowable scope and form. However, there is no domestic research as such on this. This research shows that 365 out of 900 general panel responded with experience of using the telemedicine, and 535 responded not. Most of the telemedicine users utilized telephone for the service (82.5% of general panels, 96.4% of platform users) instead of video. From the survey on what symptoms they used the telemedicine, in the case of the general panel, COVID-19 confirmed symptoms were the highest at 48.2%, followed by cold body aches (22.2%), skin diseases (6.2%), abdominal pain, indigestion, and heartburn ( 5.5%), etc. In the case of platform users, COVID-19 confirmed symptoms were the highest at 38.2%, followed by cold body aches (23.4%), skin disease (9.2%), abdominal pain, indigestion, and heartburn (7.9%). On the question whether or not the limitations of telemedicine had been explained, the respondents who answered yes was low at 54.0% of the general panels and 44.7% of the platform users. As for the time required for diagnosis and counseling (from the start of treatment to the end), 45.8% of the general panels and 66.8% of the platform users responded that it took less than 5 minutes. The percentage of respondents willing to use telemedicine in future again was 50.7%(willing) and 9.0%(very willing). In the case of platform users, 27.4% for willing and 70.6% for very willing. The consumer preference by willingness to pay (WTP) was high for the case where 1) First visit + return visit is possible, 2) Clinic level + hospital level is possible, 3) Only hospitals and clinics within a certain distance from the residence can be selected, and 4) Delivery of medicines possible (2-3 days). The willingness to pay price according to the form of telemedicine can be calculated by adding up the price for each attribute. For example, in the case of a combination of clinic level + hospital level, hospital and clinic within a certain distance from the residence, first visit + return visit possible, drug delivery service available, the willingness to pay is KRW 28,099 (= KRW 8,421 + KRW 8,007 + KRW 10,518 + KRW 1,153). Digital technologies are characterized by the empowerment and increased participation of consumers. As a result of the survey, 1) users of telemedicine are very willing to use it in the future, 2) utilization is high in urban areas, 3) women in their 20s and 30s and 40s have a particularly high rate of utilization, and 4) patients want to be provided with more options. (Up to the hospital rather than the limit of the clinic, and up to the first visit rather than the limit of re-examination). It is expected to solve the medical blind spots in the daily life as well as in the mountainous and remote areas. Telemedicine is also valuable when it is effective based on safety, just like regular medical care. Therefore, it is necessary for the expert group to make efforts to set up guidelines and to enforce them.