Email consultation: co-pay or no-pay?

October 21, 2013 Volume 19 Issue 4
  • 6% of parents say they can currently get email advice from their children’s usual site of health care.
  • 77% of parents said they would be likely to seek email advice for their children’s minor illness if that service were available.
  • 49% of parents say the co-pay for an email consultation should be $0.

Children often experience minor illnesses or injuries, leaving parents to decide whether to take them to a health care provider. Many parents are familiar with the challenge of scheduling a sick visit appointment, having to miss work or school, and rousing a child who doesn’t feel well. In this situation, parents may appreciate the option to email a child’s physician to get advice, rather than come in for an office visit.

Although typical primary care office visits for sick care may have co-pays of up to $30, co-pays for email consultations have not been established. To explore this issue, the C.S. Mott Children’s Hospital National Poll on Children’s Health asked a national sample of parents about their desire for email consultation for their child’s minor illness or injury and their willingness to pay for this convenience.

Parents’ Opinion on E-mail Advice

Only 6% of parents say they can currently get email advice from their children’s usual site of health care. However, 77% said they would be likely to seek email advice for their children’s minor illness if that service were available at their children’s usual place for care.

Parents’ current co-pay amount for an office visit for sick care ranges from $0 to over $30. In contrast, many parents say that a reasonable co-pay for an email consultation about a minor illness should be substantially less than an in-person visit (Figure 1).  Nearly half of parents say the co-pay for an email consultation should be $0.

About half of parents (49%) think the co-pay for an email consultation should be less than their office visit co-pay, while only 10% think a reasonable email co-pay would be more than the office visit.

There were no differences in reasonable co-pay amounts based on parent education level or child age. However, parents of children with a chronic condition (who are more likely to have visits for minor illness) were more likely than parents of children without a chronic condition to cite $0 as a reasonable co-pay for an email consultation.

Implications

Most parents have experienced the inconvenience associated with scheduling and attending a sick visit appointment. Email consultation in lieu of an office visit allows parents to avoid scheduling hassles, allows sick children to remain at home, and may be available after-hours when the office is not open.

Despite these benefits, over half of parents feel the co-pay for an email consultation should be less than the amount they pay for an office visit, and nearly half of parents feel they should pay nothing for an email consultation with their child’s doctor. Surprisingly, among those most likely to feel they should pay nothing for email consultations are parents of children with chronic conditions—whose children make more doctor visits than healthy children, and who thus would stand to benefit most from email consultation.

The results of this poll mirror the concerns that health care providers have expressed about email consultation. Providers argue that parents do not appreciate the unseen workload of email consultation, such as reviewing the child’s medical history, and documenting the email exchange within the child’s medical record. They worry about the expectation that they are “on call” to answer emails at all hours of the day.  There are financial concerns because office visits have established reimbursement patterns, while reimbursement for email consultation is highly variable. Finally, the cost of implementing systems to ensure the privacy and security of email exchanges may be substantial.

Some healthcare practices are already offering email consultation as part of a package of online/electronic services that also includes family conferences, texting, and web chats. Rather than a per-transaction charge, these practices charge a monthly or annual fee for the package of services. Given this poll’s finding that most parents do not expect a co-pay for email consultation, instituting routine fees for e-communication might be a workable solution.

Data Source

This report presents findings from a nationally representative household survey conducted exclusively by GfK Custom Research, LLC (GfK), for C.S. Mott Children’s Hospital via a method used in many published studies. The survey was administered in June 2013 to a randomly selected, stratified group of parents age 18 and older with a child age 0-17 (n=1,420) from GfK’s web-enabled KnowledgePanel® that closely resembles the U.S. population. The sample was subsequently weighted to reflect population figures from the Census Bureau. The survey completion rate was 51% among the panel members contacted to participate. The margin of error is ± 2 to 4 percentage points and higher among subgroups.

C.S. Mott Children’s Hospital National Poll on Children’s Health
Director: Matthew M. Davis, MD, MAPP
Associate Director: Sarah J. Clark, MPH
Manager & Editor: Dianne C. Singer, MPH
Data Analyst: Acham Gebremariam, MS
Web Editor: Anna Daly Kauffman, BA

Findings from the C.S. Mott Children's Hospital National Poll on Children's Health do not represent the opinions of the investigators or the opinions of the University of Michigan. The University of Michigan reserves all rights over this material.

Questions were answered by adult respondents age 18 and older with a child age 0-17.

Q1. At your child(ren)’s usual health care practice, are you able to use the practice’s website or email system to do the following “patient care” tasks?

  Yes, through the practice website Yes, by email to the practice No, by phone or in person only Don't Know
Get advice regarding your child's minor illness or injury        

Q2. If your child(ren)’s usual health care practice offered patient portals, how likely would you be to use the portal for the following patient care tasks (if your child needed them)?

  Very likely Somewhat likely Not likely
Get advice regarding your child's minor illness or injury      

Q3. At your child(ren)’s usual health care practice, what is your co-pay for a minor illness visit?

  • $0
  • $5
  • $10
  • $15
  • $20
  • $25
  • Other: $[WRITE-IN]

Q4.  In your opinion, at that same practice, what would be a reasonable co-pay for an email consultation regarding a minor illness for your child?

  • $0
  • $5
  • $10
  • $15
  • $20
  • $25
  • Other: $[WRITE-IN]

Participants were also asked demographic questions on gender, race/ethnicity, annual household income, education and insurance status.

All information is the sole property of the University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health.  It can only be used if there is an acknowledgment that "The information came from, is copyright by and is owned by and belongs to the Regents of the University of Michigan and their C.S. Mott Children's Hospital National Poll on Children's Health. It cannot be republished or used in any format without prior written permission from the University."

C.S. Mott Children’s Hospital National Poll on Children’s Health
Director: Matthew M. Davis, MD, MAPP
Associate Director: Sarah J. Clark, MPH
Manager & Editor: Dianne C. Singer, MPH
Data Analyst: Acham Gebremariam, MS
Web Editor: Anna Daly Kauffman, BA

Click on an image to download the full-size version

Infographic: Co-pay for office visit vs. parents' reasonable co-pay for an email consultation

Video