This Was Predictable

But the folks at Kaiser still don’t understand it. The results:

When Ted Palen, a Kaiser Permanente researcher, started investigating what happens when doctors begin e-mailing with patients, he thought he would see the practice lighten workloads. Patients would get their questions answered remotely, with no need to turn up in person.

Palen just finished a five-year retrospective study of what happened when Kaiser Permanente in Colorado began allowing e-mail access to doctors in 2006. The outcome, as Palen notes in this week’s Journal of the American Medical Association, was “contrary to our expectations”: Online access to doctors was associated with more doctor visits, not fewer.

That initial spike did taper off with in a few months. Even a year later, however, those who utilized the online access to doctors still had higher rates of doctor visits per month.

As an HMO, Kaiser rations by waiting. When you lower the time price of care, the demand increases. DUH.

Comments (9)

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  1. Johnny says:

    I’m not sure I understand how this was predictable. In my understanding, if there is more access to online services instead of patients having to go to medical insitutions to see a physician for something that could have been handled online, then shouldn’t this reduce the price patients have to pay? Online services should facilitate the interaction between patients and doctors, therefore making it less neccessary for patients having to go see doctors in person and, therefore, incurring fewer costs. I feel like maybe I’m missing a point here.

  2. Devon Herrick says:

    When Kaiser initiated email and phone consultations in Hawaii, the number of in-office visits fell an equivalent amount to the number of new electronic consultations. There is one major difference between Hawaii and Colorado, however. In Hawaii, many people had to travel long distances, board a plane or get on a ferry to get to their doctor. People were substituting electronic consultations for less convenient in-office visits. By contrast, Kaiser enrollees in Colorado may have the idea that all health conditions that are serious necessarily must result in an office visit. AS a result, people in Colorado may have used the initial email consultation to gauge whether there was a need to make an appointment for an in-office visit.

  3. Saul says:

    Interesting study.. Maybe people who are willing to email doctors to see what is wrong with them are much more likely then to go to the doctors office.

  4. Cindy says:

    Devon’s analysis is interesting. It seems that making these services available with the stipulation that they be used only for minor things (coughs, flus, colds, prescription refills) may decrease frivolous office visits.

    Many doctors practice this informally already by calling in prescriptions for common conditions where patients can more-or-less self-diagnose.

  5. August says:

    To get a better idea of the impact we should also look at long term health outcomes of the cohorts. Perhaps it deceases long term spending?

  6. Wasif Huda says:

    I am not surprised. More communications garners more customers. That said, one should also consider the self-selection process. People who communicate with their doctors over the email and eventually proceed to meet with a doctor in person, are by nature, more avid consumers of health services. And so, regardless of email services or not, this segment of the population were going to consume; the quantity consumed, however, may vary.

  7. Devon Herrick says:

    It appears the sample was anything but random. From what I read, Kaiser enrollees could self-select and signup for EMR and online access to their physicians. This suggests those most in need (or perceived need) of greater access to their primary care physician were able to boost their access by merely signing up for this service. To really gauge the effect of electronic access to physicians on enrollee behavior, you would need to randomly assign enrollees to either the control group or the treatment group and then compare the results before and after the treatment affect. It does not appear this research was done this way.

  8. Kyle says:

    @Devon, the VA instituted a similar program with e-benefits and a tele-help system, specifically to help marginalized rural veterans. Although the phone system is still going strong, vets have about a 40% chance to actually reach an operator and receieve correct answers. There was also very little evidence to suggest it had any meaningful effect on the frequency of visits when access was increased.

  9. seyyed says:

    also, it seems difficult to diagnose or give advice through email, which is probably why once the intial email exchanges took place, patients and doctors thought it better to meet in person