Economic Evaluation of an Investment in Medical Websites and Medical Web-Based Services

27 Research Contributions

As it was aforementioned throughout this research thesis, healthcare is a unique and complex economic sector much different from any other. It is a sector highly institutionalized, under great government influence and facing crucial resource allocation issues that threaten the stability of healthcare systems and the survivability of healthcare units worldwide. Especially in this period of the worldwide economic downturn, rapid changes are applied and many resources invested aiming to sustain the survivability of the healthcare and improve its overall efficiency.

Evaluation of the processes, interventions and the IS in healthcare system is urgently required since the newly born and constantly developing e-Health web-based services can be a “deus ex macina” solution to the efficiency and resource allocation problems. Especially the medical websites and the web-based services that they offer are a promising emerging market that can contribute to higher efficiency and the further evolution of the healthcare systems.

Contribution 1: The comprehensive investigation of the extant literature showed that until now evaluation methods like Cost-Benefit Analysis were used in healthcare with the primary purpose to evaluate medical treatments, treatment processes and enhance medical education, rather than focusing on evaluating processes and technological changes and interventions in healthcare and apply in healthcare sector what was successfully used in other economic sectors such as business and manufacturing. Evaluation methods can be a powerful tool in the hands of managers/analysts/decision makers who more and more these days need to focus on methods that will support strategic decisions and enhance the viability and efficiency of healthcare units. Furthermore, although past studies regarding the evaluation and assessment of medical websites were focusing on the accuracy of the medical content that the sites contain, the readability and comprehensiveness of information or the evaluation of the sites based on ranking tools and sites, the aim of this research was to form a comprehensive sample as a good representation of the population of the medical websites and provide based on objective data to assess the factors of success and the factor that can enhance the survivability/sustainability of the medical websites. The findings were interesting and the knowledge that was derived for the population is considered significant.

Delving into the past studies, Cost-Benefit Analysis is considered to be a comprehensive method of economic evaluation presenting many benefits as well as some drawbacks. To enhance its effectiveness, CBA was used in this research in the context described by Robert Brent (2003), as a general method that included also Cost-Efficiency Analysis, Cost-Minimisation and Cost-Utility Analysis as its special cases. Problems such as valuing human life, identifying costs and future benefits and the issue of discounting costs and benefits, are issues that emerged from background knowledge and should be taken under consideration. From the analysis of the past literature, the value of human life in finite values can be assessed from the monetary compensation that an individual would ask in order to work and live in a completely unsafe environment (Sugden and Williams, 1978). Benefits and cost are considered to be both discounted as literature shown that this is a way to produce correct outcomes from the evaluation process avoiding problems like the Postponing Paradox (Brent, 2003; Smith and Gravelle, 2000b; Keller and Cretin, 1983).

In order to obtain a monetary value of the benefits concerning the use of the medical websites that offer medical web-based services to the users/patients, the Willingness to Pay approach was followed rather than the QALYs approach, because, as it was stated from the literature, the QALYs tries to transform the outcomes of the improvement in the healthcare interventions into a specific duration and quality of life (Bala et al., 1998; Hammit, 2002). In addition to this, QALYs and Cost Effectiveness Analysis are mainly used for clinical outcomes while WTP can be used on assessing value from the health process itself rather than only from its outcomes (Ryan et al., 1997).

Moreover, by estimating also the ratio of net benefits that a programme produces to the costs that it needs in order to operate, (Endogmus et al., 2004), which is the Return on Investment approach, we ended up with a clear view of the evaluation results of the medical websites that offer medical web-based services.

In addition, the web presence of any kind of certification, although is an easily understandable by the users indicator of the quality of the medical websites, does not seem to affect neither the success/ excellence of the websites nor their lifespan duration. On the other hand the nature/structure of the organization that supports/provides the website seems to have a great impact on the excellence of the website with websites supported/ provided by governmental institutions and other non-for-profit organization ranked higher and present greater survivability/sustainability compared to the websites that are supported by profit organizations. It is assumed that one possible explanation is that the users are suspicious about the underlying motives of the website supported by profit entities to mislead them and promote their own products. In addition to this, from the data analysis it was derived that the medical websites that their content is strictly restrained around a very specific healthcare issue or conditions tend to underperform compared to websites that their content covers a variety of conditions. In general it is logical “General information” medical websites to attract a wider range of users and present better traffic, more visits referred from search engines, more unique visits and more websites that include their links/articles/content. Users tend to spend also more time in this category of websites.

Furthermore, medical websites that have governmental or research funding as a source of revenue tend to outperform in comparison with websites that support online shops and advertise medical products as a source of income. These results coms in accordance with past studies that have shown that in general users tend to mistrust websites that present great amount of advertisement, influenced maybe from the possibly unethical motivation that the website may have to provide them with misleading piece of information in order to drive them to prefer the advertised products (Walther et al., 2004).

The highest ranked websites present also much higher web presence in social networks and the users tend to spend more time on them while a greater percentage of their visits are referred to from search engines, something that might is the effect of their reputation. The percentage of visits referred to from search engines is mainly influenced by almost the same factor that influecing the global rank value of the websites. So it is majorly affected by factors that contribute to the success of the medical websites. Moreover, they present much higher lifespan duration.

Finally, trying to identify the factors that enhance the survivability of the medical websites it was concluded that are almost the same factors that affect the success or excellence of the medical websites with the most “long-lived” websites to be supported by non-profit organizations, to offer the ability to the users to locate medical services in close proximity from their location , they have greater web presence in social networks, better rank and in general a higher and more stable traffic flow and other related measurements as well as the users tend to spend more time on average on them.

Contribution 5: In order to assess the value of the medical websites’ offered services and web-based services first we estimated the “Benefits” an then the “Cost”, associated with their use.

The “Benefits” were assessed by estimating the broader value that the services/web-based services offered by the medical websites, have on the users. For this purpose the use of contingent analysis and more specific of the Willingness to Pay (WTP) approach in an online survey setting was decided, after a comprehensive study of the literature and comparison of WTP with the most popular methods used in healthcare evaluations; QALYs and the Human Capital Approach

The “Costs” were assessed using a sophisticated webpage ranking and traffic moderator tools, as extensions of current web-browsers. The sample that was used in order to assess the costs related to the operations of the medical websites was the same sample of the 316 medical websites, used previously for assessing the factors that majorly affect the success and the survivability of the medical websites.

The stakeholder analysis identified as key stakeholders involved in the medical website’s operations the following:

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  The Government/ Ministries of Health
  
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  Private Hospitals and Hospital networks
  
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  Individual medical practitioners and Medical Practitioners Associations
  
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  Non-for-profit Organizations
  
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  Patients’ Associations and Individual patients/users
  
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  Web-content providers and other relevant stakeholders
  
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  E-publishers
  

Finally, the Willingness to pay survey to assess the “benefits” of the use of medical websites’ services and web-based services and through this to end up to an attached monetary value to them, revealed that most of the participants (74.7%) were willing to pay an average of £6.44 or around £9 according a more optimistic estimation approach.

This led to a calculation of the CBA ratio (benefits to cost) around 2.41 with the conservative approach and 3.37 according to the more optimistic calculation. These results showing that the “benefit” value or the financial yield from the operation of a medical website and the offering of interactive medical web-based services, apart from being great for the public from a societal perspective, it also covers more than 2 or 3 times the cost of the initial investment.

These results are also verified by the return on investment (ROI) calculation of 141.3% and 237.2% in the case of using the most optimistic value estimation.

These results show that an investment on a medical website can be proved very profitable not only for the public/private organization or individual who will attempt but also for a great amount of the Internet users/ patients. These calculations may seem extraordinary or too-good-to-be-true and might be considered opportunistic and that can be achieved only if accompanied with great variance on the investment (great risk). However, if we consider the fact that the Cost-Benefit analysis and the Return on Investment were applied in the emerging economic activity/business/sector of the medical websites plus the fact that healthcare sector does not rely on the conventional and traditional economic theories and models, it can be considered acquire possible and even underestimated results. In matters related to healthcare there are two factors that are universally applied throughout the sector (Kuljis et al., 2007):

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  Firstly the patient’s fear of death. The “customers” of the healthcare units are the patients, who are often experiencing the fear of death and feel that their lives are in danger. The patient’s quite ubiquitous experiences and feelings in many cases put healthcare systems under pressure and lead to irrationality.
  
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  Secondly, there is the society’s pressure both to the healthcare system itself but also to politicians for the provision of the “perfect” healthcare system, something that is impossible to be achieved due to the complexity and the above mentioned characteristics of this sector.
  

These two specific factors create inelastic demand in the economy, making business activities related to healthcare quite profitable under a correct and inspiring management.