Economic Evaluation of an Investment in Medical Websites and Medical Web-Based Services
Download 1.95 Mb.
|
- Navigate this page:
- Chapter 7: Discussion and Concluding Remarks
25 Concluding RemarksIn this chapter attempts were made to assess the value of managing a medical website in the context of Cost-Benefit Analysis (CBA) and Return on Investment (ROI). In order to assess the value of the medical websites’ offered services and applications first we will estimate the “Benefits” an then the “Cost”, associated with their use. The “Benefits” were assessed by estimating the broader value that the services/applications, which are offered by the medical websites, have on the users of these services. 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 comprehensive study of the literature and comparison of WTP with the most popular methods used in healthcare evaluations; QALYs and the Human Capital Approach, that will be analysed further below. The “Costs” were assessed using sophisticated webpage ranking and traffic moderator tools, as extensions of current web-browsers. The sample that will be used in order to assess the costs related to the operations and service offering of the medical websites was the same sample of the 316 medical websites, used previously in the afore mentioned study 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:
From those main actors, the individual governments/ Ministries of Health/Other official policy makers the medical practitioner’s associations as well as the patient’s associations are those stakeholders with the stronger engagement, influence and interest towards the operations of the medical websites. Moreover the Willingness to pay survey to assess the “benefits” of the use of medical websites’ services and applications 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 ROI calculation that shows a return on investment of 141.3% and 237.2% in the case of using the most optimistic value estimation. Although these calculations may seem extraordinary or too good to be true since these percentages can 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 that healthcare sector does not rely on the conventional and traditional economic theories and models, it can be considered quite 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):
These two specific factors create inelastic demand conditions in the economy, making business activities related to healthcare quite profitable under a correct and inspiring management. Chapter 7: Discussion and Concluding Remarks26 Research SummaryThis research thesis was motivated by the scarcity of implementation of economic evaluation processes in the organizational and technological interventions in the healthcare field in contrast to the plethora of the evaluation studies referring strictly to the cost-efficiency of strictly medical interventions. Before presenting the contributions of this study along with its limitations and future steps, a thesis summary is presented as follows: Chapter 1 provided a thesis introduction and overview. An overview of the healthcare field, the role of evaluation, the necessity for the economic evaluation of the IT interventions in the healthcare and especially of the emerging market of the medical websites are presented. Moreover in accordance to the main aspects and motivations towards this research, the main aims and expected contributions of this research thesis are presented. Chapter 2 comprehensively reviewed the background knowledge and past studies on the evaluations of the healthcare IT interventions and on the current web-based services of the Cost- Benefit analysis and Return on Investment in this field. Through this review, the knowledge gaps regarding the economic evaluation of the use and investment on medical websites were identified. Moreover, the newly-acquired knowledge from this chapter was used as the basis of the methodology formation. Evaluation in general and in healthcare is the first issue in extant literature debates. Extant literature provides a variety of views about the advantages of the application of an evaluation process, and highlights that the application of these processes in an emergency for the healthcare sector. The lack of the incorrect application or non-application at all of these methods is suggested to be one of the major reasons of the inefficiency in the healthcare field. In order to apply evaluation in healthcare it is vital to evaluate the processes and the information technology since these can directly affect the efficiency, safety and the quality of the processes and is technology that results in the final outcome of the service delivered. As the progress of the analysis of background knowledge on the aspects of this research continues, the focus is narrowed down to the methods that were used in this research for the evaluation. Until now these methods were used in healthcare with main purpose to evaluate medical treatments, treatment processes and enhance medical education rather than focusing on evaluating organizational changes, processes and ethics observing healthcare units as entities and apply in healthcare sector what was successfully used in other economic sectors such as business and manufacturing. Issues concerning Cost-Benefit Analysis caused huge debates among the scientific community are presented, its advantages and disadvantages based on previous studies are analysed as well as suggestions for the correct application of the method and the correct interpretation of its results. Problems from the use of different discount rates for costs and benefits were also identified and investigated, including the Postponing Paradox and in general problems concerning the allocation of resources. Past suggestions, opinions and debates also exist on issues concerning the cost type selection the Willingness to Pay (WTP) approach the broader social perspective of this method and the uncertainty involved. Finally, researchers, analysts and academics debate about the use of market values in cost benefit analysis the difficulties to assess the value of intangible effects and the difficulty to assess the border social value from the implementation of this method on public goods. Finally, very few studies on ROI in healthcare technology were identified and the field is considered “incomplete” because it does not take into consideration the perspective of the patients and the medical practitioners that are affected by the technology in healthcare. ROI of medical technology, from the patient’s perspective, is measured in terms of how safer it makes the provided medical services and how much it enhances the total effectiveness of the healthcare (Frisse, 2006). Finally, Willingness to Pay (WTP) is considered as a promising method to evaluate the behavioural responses of the public in general or a specific target group towards a specific scenario, product, and service or attribute (Rose et al., 2009) and it was used in the research to assess the benefits from using web based healthcare intervention. Chapter 3 provided the methodological steps followed during this research process. The first methodological step to achieve the aims of this research was the formation of a sample of the population of the Anglophone medical websites, belonging into different categories, according to their content, and having as targeted audience people with different needs and/or conditions. The newly-formed holistic framework for the evaluation of the medical web-based services was formed based on past well-established frameworks for the evaluation of IS interventions in general and in the healthcare field. In order to identify the factors of success and failure of the medical websites, a feature selection process was followed. The sample’s medical websites were firstly ranked according to their global rank, and the characteristics of the higher and the lower ranked medical websites were compared in order to identify the characteristic/features that present great difference among them and can be considered as factors that affect the grade of excellence and the sustainability/survivability of the medical websites. The impact of these factors were assessed then, using statistical methods and more specific regression models. In order to identify the benefit (value) of an investment in medical websites to compare it with its cost for the Cost-benefit analysis application, a Willingness to Pay approach was adopted in an online survey setting. This survey had two aims: a) to identify the value (benefit) that the users consider to have from the use of services offered by a medical website and b) to identify their willingness to pay towards the services offered from medical websites in order to identify the value (profit) that an investment on a medical website might have. For the spreading of the survey novel crowd-sourcing techniques were used The task to assess the costs related to the operations of the medical websites and the medical web that they offer to the public is a very complicated task that cat can lead to inappropriate and misleading estimations during the economic evaluation of the medical web-based services. Thus instead of estimating the costs related to the medical websites’ operations we estimated the cost of acquiring and managing a website like this.
In order to investigate the factors that can affect the success and the survivability of the medical websites, a sample of the population of the Anglophone medical web sites was used to obtain a comprehensive dataset, which was then analysed using statistical feature selection. After examining the basic characteristics of the sample, the next step was to form a ranking of the sample’s medical websites, according to the value of their global rank variable, and compare the higher and the lower ranked medical web sites in order to discover those characteristics/features that present significant difference among them. These characteristics/features can be considered as factors that affect the grade of excellence and the sustainability/survivability of the medical websites. The factors/variables that presented significant difference between the highest and the lowest ranked medical websites were considered a-priori correlated to the success of the site and were used in order to construct a regression model to investigate to what degree these factors may or may not affect the rank and the success of the medical websites. The statistically significant variables of this regression model, were used again as criteria to rank again the sample’s medical websites and create a final ranking of the highest and the lowest websites. After this stage, we proceeded to investigate further their differences. The same feature selection context and the same process of building form a regression model were used also in order to select and examine the impact that some variables can have on the frequency with which the medical websites appear in search engines (Google.com, Yahoo.com, Ask.com, etc.) and on the time that the users tend to spend on the websites. Chapter 6 provides the Cost-Benefit and Return on Investment ratios application after the careful assessment of the costs and the “benefits” related to the operations of the medical websites. Innovative tools were used for the as more-accurate-as-possible assessment of the costs involved in the operations of a medical website, while for the assessment of its benefits for the users as well as for the website’s administrators, a Willingness to Pay approach in an online survey setting was employed. For the purpose of the survey, novel crowd-sourcing techniques were used to lead to as-more-unbiased-as-possible sample of participants, so that the survey to produces valid results and useful knowledge. The CBA for a programme was calculated as:
The ROI for a programme was calculated as: 
Finally, the results appear to be promising for investment in the emerging market of the medical websites and medical web-based services and services. Chapter 7: This chapter discusses the limitations of this research, the problems that appeared during the research evolution, as well as the actions taken in order to solve this issues in order to enable the current research to produce valid results and useful scientific knowledge. Finally, it summarises the main conclusions of this research and evaluates research outcomes. Moreover, this chapter examines the applicability of the finding, and provides directions for future researches required in the emerging field of the medical websites and medical web-based services and services. The data analysis process focuses on objective data based on the medical websites’ traffic flow estimations and rankings rather than on subjective data having to do with the readability of the websites’ contents, the appearance and the accuracy of the medical websites as past researches did.
Download 1.95 Mb. Share with your friends:
|
