Web portals in primary care: an evaluation of patient readiness and willingness to pay for online services

J Med Internet Res. 2006 Oct 26;8(4):e26. doi: 10.2196/jmir.8.4.e26.


Background: Online Web communication between physician and patient has been proposed by leading primary care organizations as a way to enhance physician-patient communication, but lack of payment for this service has acted as a significant barrier to implementation.

Objective: This study evaluates current patient readiness and willingness to pay for online services in a fairly typical urban family medicine practice.

Methods: All patients that visited the author for medical care during a one-month period in the spring of 2006 were anonymously surveyed with a one-page survey instrument that inquired about demographics, willingness to pay a small annual fee for online services, the greatest fee they were willing to pay, and their most desired service.

Results: A total of 346 patients out of 2380 active patients in the study practice (14.5%) were surveyed. The valid survey response rate was 95.1% (329/346.) Three quarters, or 75.4%, of patients had Internet access. The group with the highest access were 18- to 29-year-olds (97%), and the group with the least access were those 70 years and up (56%) (P < .001). Categorized by employment, students and employed patients had the best access at 92% and 87%, respectively, and retirees and disabled patients had the worst access at 66% and 42%, respectively (P < .001). Of all patients with Internet access, 74.6% (n = 185) were willing to pay a small annual fee for one or more of the following online services: viewing of parts of their medical record, messaging with their physician, medication refills, appointment requests, and billing inquiries. Willingness to pay did not vary significantly by age (P = .06). Of all respondents, regardless of Internet access, 47.1% (n = 155) were willing to pay US $10 or more per year, with the median amount being US $20. Of those with Internet access (n = 248), 60.1% (n = 149) were willing to pay US $10 or more per year, and 31% were willing to pay US $50 or more per year. The three most important services to patients with Internet access (n = 248), in order of importance, were emailing with their physician (34%), Internet viewing of their medical record (22%), and medication refills (11%) (P < .001).

Conclusions: This study suggests that patients of all ages are currently ready and willing to pay a small annual fee for online services with their primary care physician's office. If 47.1% of a practice of 2500 patients each paid US $10 per year for online services, the annual revenue generated would be US $11775. Not only does this study support the economic feasibility of patient Web portals, but it suggests that online services could form a new line of revenue for primary care physicians.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude to Health
  • Fees, Medical / statistics & numerical data*
  • Female
  • Financing, Personal / economics*
  • Financing, Personal / statistics & numerical data
  • Health Education / economics
  • Health Services Accessibility / economics*
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Internet / economics*
  • Internet / statistics & numerical data
  • Male
  • Middle Aged
  • Primary Health Care / economics*
  • Primary Health Care / statistics & numerical data
  • Surveys and Questionnaires