Physicians' perceptions towards the impact of and willingness to pay for clinical computerization in Hong Kong

Abstract

Background and objectives: We evaluated factors associated with physicians' perceptions towards the effects of computers on health care and on current levels of computerization in their practice. We also performed a contingent valuation to quantify physicians' perceived benefits from computerization in a hypothetical ambulatory, solo clinic. Methods: We surveyed 949 representative physicians in Hong Kong by post. Factor analysis was performed to summarize similar items into categories. Multivariable log-linear regression models were employed to assess the relationships between different factor scores and the number of functions computerized. We elicited their willingness-to-pay (WTP) for three defined computer systems using contingent valuation techniques. WTP values were estimated using econometric modeling by both, parametric and geometric methods. Sociodemographic, attitudinal, and practice-related predictors of WTP were estimated through regression analyses. Results: Factor analysis revealed a three-factor solution which explained 53% of total variance. The overall mean score (mean=3.51±0.45) showed a generally positive attitude towards the effects of computers on health care. Respondents with a higher level of computer knowledge had significantly higher mean overall (P=0.002) and factor scores for all three factors (P<0.01). Higher factor scores on the effects of computers on patient care and clinicians (P=0.006) and on the health system (P=0.032) were associated with a higher number of functions computerized. The parametric median WTP values for computerizing administrative, clinical, and both sets of functions were HK$ 21,205 (US$ 2719), HK$ 34,231 (US$ 4389), and HK$ 45,720 (US$ 5862), respectively, which were lower than the estimates obtained from demand curves using the geometric method [HK$ 43,286 (US$ 5549), HK$ 59,570 (US$ 7637), and HK$ 84,623 (US$ 10,849), respectively]. Doctors with higher incomes were willing to pay more to computerize the clinic, with strong dose-response gradients demonstrated. Those who worked in corporate settings were also more likely to accept higher WTP values. Conclusions: Our findings confirm that better knowledge about computers is contributory to a more positive attitude towards the effects of computers on health care, which is in turn significantly associated with higher levels of actual computerization in clinical practice. WTP values represent the likelihood, in monetary terms, of translating doctors' perceived benefits from computerization into investment action. © 2004 Elsevier Ireland Ltd. All rights reserved.