Patients' willingness to use, willingness to pay, preferences for digital chronic disease management service packages of internet hospitals in China: A cross-sectional survey.

OBJECTIVE: Digital chronic disease management (CDM) service packages are an emerging service type of telemedicine platforms. This study aims to examine patients' willingness to use (WTU), willingness to pay (WTP), and preferences for digital CDM service packages of internet hospitals among hospital outpatients in China's high-income regions. METHODS: A cross-sectional study was conducted across the outpatient settings of multiple hospitals in Zhejiang province, which ranked first in per capita disposable income of urban residents among all China's provinces. RESULTS: Among 1262 participants, 63.47% (801/1262) had WTU, 45.25% (571/1262) had WTP. Binary logistic regression analyses showed that younger age, higher education levels, having chronic disease, and being an online health information seeker were significantly associated with greater odds of both WTU and WTP. Higher monthly income (8001-17,000 CNY vs. ≤2000 CNY) was significantly associated with WTU, while higher monthly income (>17,000 CNY vs. ≤2000 CNY) and having basic medical insurance were significantly associated with WTP. Among 571 participants with WTP, more than 80% preferred physician-led packages at >300 CNY/month, 10.51% preferred nurse- and health manager-led packages (100-300 CNY/month), and 7.53% preferred AI-assisted platform and medical staff packages (<100 CNY/month). Ordered logistic regression found that marital status (divorced) was the only significant factor for package preferences, though this should be interpreted with caution due to limited subgroup size. CONCLUSION: Findings replicated and extended the Andersen Behavioral Model and Grossman Model to the context of digital CDM services. A distinct economic threshold separated WTU from WTP for digital CDM service packages: WTU emerged at moderately high income levels, while WTP required high income and basic medical insurance coverage. Financial affordability constituted a substantial barrier. Among willing-to-pay patients, the majority preferred physician-led packages, suggesting that doctors should retain a central role in digital CDM service delivery.