title: [Online medical consulting service at the University Hospital Zürich before and after introduction of a service fee].
abstract: OBJECTIVE
  The University Hospital of Zürich has been providing an anonymous online consultation service since 1999. In January 2008 a service fee of CHF 20.- was introduced. The present investigation evaluated the impact of the service fee on the use of the medical online consulting service.
  
  
  METHODS
  All 8269 requests between January 2007 and December 2008 were analysed using the following criteria: number, complexity and subjects (ICD-10) of the requests, personal statements of the users and evaluation of the online answers.
  
  
  RESULTS
  The number of requests decreased by 69 % (6298 vs.1971) and the age of the users rose from 36 +/- 16 to 40 +/- 17 years. The text length of the requests increased (characters: 677 +/- 463 vs. 801 +/- 539), as did the length of the answers (characters: 1397 +/- 3224 vs. 2391 +/- 4327). In 2008 the assistance of specialists at the University Hospital Zürich were called upon more frequently (11.1 % vs. 15.9 %). Regarding the assessments of the quality of the answers, there were differences in the range of positive evaluations ("good": 38 % vs. 41 %, "excellent" 43 % vs. 36 %).
  
  
  CONCLUSIONS
  The introduction of a new service fee resulted in a decrease in requests. At the same time, a greater number of older people used the service, and they asked questions that are more complex. Apparently, persons that probably have more medical problems have greater appreciation for the opportunity to ask questions and, in comparison to younger persons, are more willing to pay for the service. The continued positive evaluation given to the medical answers shows that an Internet service involving a fee can also be a useful supplement to the conventional physician/patient relationship.
authors.affiliation: Universitätsspital Zürich, Geschäftsstelle E-Health, Zürich, Schweiz. christiane.brockes@usz.ch
authors.forename: M C
authors.initials: MC
authors.lastname: Brockes
authors.forename: R P
authors.initials: RP
authors.lastname: Neuhaus Bühler
authors.forename: E
authors.initials: E
authors.lastname: Schulz
authors.forename: C L
authors.initials: CL
authors.lastname: Neumann
authors.forename: S
authors.initials: S
authors.lastname: Schmidt-Weitmann
mesh_terms: D000328:Adult; D000367:Age Factors; D003258:Consumer Behavior / Q000191:economics; D003376:Counseling / Q000191:economics* / Q000706:statistics & numerical data; D005249:Fees and Charges; D006785:Hospitals, University / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics*; D010817:Physician-Patient Relations; D019114:Remote Consultation / Q000191:economics* / Q000706:statistics & numerical data; D013557:Switzerland; D014600:Utilization Review / Q000706:statistics & numerical data; D055815:Young Adult