Exploring the freemium business model for online medical consultation services in China

Online medical consultation (OMC) is an emerging form of e-health service that is gaining popularity both within China and worldwide. Among the various issues facing OMC, patients’ sustained participation and payment remain challenging. This study seeks to understand the relationship between patients’ initial and subsequent OMC participation and their payment behaviors using an established OMC platform in China (i.e., Haodf.com). By drawing on a goal-directed perspective, this study explores patients’ OMC participation (i.e., information provision quantity, reply time, and payment) at two stages of the goal pursuit process (i.e., initial versus subsequent). Moreover, we investigate the potential differences between the freemium (i.e., try-before-you-buy) and direct pay patients. Hierarchical linear modeling analysis of 34,706 OMC service records reveals that initial patient information provision (as measured by quantity and reply time) significantly impacts the patient's subsequent information provision and payment. However, a timely reply from the doctor facilitates the patient's subsequent information provision but does not influence payment decisions. Freemium patients and direct pay patients do not differ significantly in most participation measures. These findings offer insight to OMC platforms and service providers who wish to enhance sustained patient participation.