• Kenneth G Adler.
• Department of Family and Community Medicine, University of Arizona, 5300 E Erickson, Suite 108, Tucson, AZ 85712, USA. kadler@azacp.com
• J. Med. Internet Res. 2006 Jan 1; 8 (4): e26.

BackgroundOnline 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.ObjectiveThis study evaluates current patient readiness and willingness to pay for online services in a fairly typical urban family medicine practice.MethodsAll 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.ResultsA 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).ConclusionsThis 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.

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