Willingness to use and pay for a virtual urgent care service among emergency department patients in Singapore: a cross-sectional study

Hospitals are often crowded places, and their emergency rooms are no exception. When people feel unwell but not critically ill, they sometimes still end up waiting for hours in these busy departments, competing for attention with those in life-threatening danger. This overcrowding strains the system, leading to longer waits for everyone and inefficient use of resources. To solve this, health systems have begun exploring virtual urgent care, a model where patients can speak with a doctor or nurse through a video call or phone before deciding to go to the hospital. The idea is to sort out minor issues remotely, saving time and effort for the patient while keeping the emergency room free for true emergencies. However, for this system to work, it relies on people actually using it. It is not enough for the technology to exist; patients must trust it, understand when it is appropriate, and be willing to pay for it if a fee is involved.

Researchers in Singapore set out to understand exactly how people feel about this idea. They wanted to know if patients and their caregivers would choose a virtual service over walking straight into an emergency room, and how much they would be willing to pay for that convenience. The study took place in the emergency department of a major hospital in western Singapore, where the team spoke with 168 adults who had just arrived for care. Instead of asking about their current illness alone, the researchers presented them with three different hypothetical situations to see how their choices changed based on how serious the problem seemed. The first scenario involved a mild issue, like a rash, where the virtual option was a video call with a specialist. The second was a moderate problem, such as vomiting, where the service offered a nurse visiting the home with a doctor watching over the situation remotely. The third was a severe condition, like dizziness and unsteadiness, where the virtual service promised faster access to the emergency room and a shorter wait.

The results showed that people were generally open to the idea, but their willingness depended heavily on the situation. For the mild condition, about three-quarters of the participants said they would use the virtual service. As the scenarios became more serious, that number rose, reaching nearly 86 percent for the severe condition where the service offered a quicker path to emergency care. When it came to paying extra for these services, the pattern was similar. For the mild rash, most people were not willing to pay more than the standard emergency room fee. However, as the perceived danger increased, more people said they would pay above that standard fee. In the severe scenario, where the service offered earlier access to the emergency room, about 60 percent of those willing to use it said they would pay more than the usual cost. This suggests that people do not view virtual care as a single product; they value it differently depending on how urgent they feel their situation is.

The researchers also listened to the reasons people gave for their choices, which revealed what mattered most in each situation. For mild problems, the main appeal was convenience. People wanted to avoid the crowds, skip the long waits, and save time on travel. They saw the virtual option as a practical way to get advice without the hassle of a hospital visit. When the condition was moderate, the focus shifted to comfort. Participants liked the idea of a nurse coming to their home, allowing them to rest in a familiar place while still receiving professional care. They valued the ability to stay home while feeling unwell. In the most serious scenario, the priority changed again. Here, people cared less about comfort and more about speed and reassurance. They wanted to know that their symptoms were being taken seriously and that they could get a quick assessment or a faster route to the emergency room if things got worse.

The study also looked at who was most likely to use these services. People who trusted virtual healthcare and felt confident using digital technology were more likely to say yes to a video consultation. Interestingly, older adults were less willing to use the service, even when it offered a faster way to see a doctor. This suggests that while the technology is ready, some groups may need extra support, such as help from family members or clear verbal instructions, to feel comfortable using it. The researchers also tested whether the way the service was described—using positive or negative language—changed people's minds, but found that the wording had very little effect on their decisions.

Ultimately, this study suggests that for virtual urgent care to succeed, it cannot be a one-size-fits-all solution. The way it is presented to the public must match the specific needs of the patient. For minor issues, the message should highlight convenience and time saved. For moderate problems, it should emphasize the comfort of home care. For serious symptoms, the focus must be on safety, speed, and a clear path to getting the right help quickly. The researchers caution that these findings are based on what people said they would do in a hypothetical situation, not on how they actually behave when they are sick. Real-world adoption will depend on building trust, ensuring the service is affordable, and making sure that the promise of faster care does not create a system where only those who can pay get priority. The goal remains to create a system that works for everyone, keeping emergency rooms available for those who need them most while offering a helpful alternative for everyone else.