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With the development of the healthcare industry and high-speed internet facilities, eHealth has been developing rapidly worldwide. eHealth can encompass a range of services, including telehealth, telemedicine, mHealth, electronic medical records, or other health IT services. When health applications are linked to mobile devices, patients can consult online doctors via mobile phones, and doctors can treat their patients remotely. As the number of health internet users is growing rapidly, the global eHealth market is expected to grow from USD 40.82 billion in 2017 to 132.35 billion by 2023 (marketsandmarkets.com, 2018). Governments and businesses in China, India, and Australia contribute to the development of the eHealth market.
Online health consultation is a type of eHealth service in which communication between patients and doctors is offered via the internet. Patients can consult online doctors about their illnesses, and doctors can provide diagnoses, treatment plans and even prescriptions via the internet. If necessary, a patient can physically visit a doctor for further diagnosis and treatment after consulting the online doctor. Contrary to the traditional direct visit with a doctor, online health consultations help patients save considerable time and offer convenience (Chang et al., 2019). In particular, during the coronavirus disease 2019 (COVID-19) pandemic, online health consultations can help reduce the risk of cross-infection for patients with mild illnesses.
Although eHealth is playing an increasingly important role in the COVID-19 pandemic, the adoption rate of online health consultations was relatively low in China. According to a research report, 390 million Chinese people have used eHealth services, including online appointments, health information seeking, and patient-centered communication. Among eHealth users, less than half (47.6%) used online health consultations, accounting for only a quarter of the Chinese population (LeadLeo, 2020). Compared with more than half of Americans who used online health consultations, the low adoption rate limits the development of the eHealth industry (Gong et al., 2019). Therefore, understanding the factors that affect patients’ use of online health consultations seems more important than ever.
Online health consultation services are beneficial to patients, but online health services also introduce privacy risks for patients, who disclose personal information (i.e., medical consultations, medical treatments, and medicine prescriptions) on online health platforms. When patients worry that their personal information may be hacked via the internet and even be misused by unknown institutions, they may refuse to use online services. Since risks may decrease patients’ intentions to adopt technology, trust is proposed to be an effective way to mitigate the perception of risks (Gong et al., 2019; Hong et al., 2019; Lee et al., 2018; Li et al., 2020). Trust is included in the proposed model to be the antecedent of perceived benefits and perceived risks.
Although the extant research has increasingly focused on the adoption of eHealth services, such as health information systems, online seeking services, and online health forums (Chang et al., 2016; Cho, 2016; Dünnebeil et al., 2012; Hong et al., 2021; Lai & Wang, 2015; Li & Wang, 2019; Turan et al., 2015), the research on online health consultations is very limited. Since most of these studies have examined the behavioral intention or intention to use online services, the decision-making process from online to offline health services remains unclear. In addition, patients exhibit different degrees of behavioral intentions for different payment types (e.g., free or paid consultation). To the best of our knowledge, no prior studies have investigated the moderating effects of payment types on online and offline health services. Therefore, this study aims to fill the gaps by understanding patients’ decision-making processes in groups of different payment types.