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A Study on the Preferences of Chinese Cancer Patients Regarding Telemedicine from a Demand Perspective: A Discrete Choice Experiment

This study utilizes a discrete choice experiment to reveal that Chinese cancer patients prioritize favorable physician ratings, chief physician consultations, and specific digital features over cost, providing evidence for optimizing telemedicine services through high-quality provider engagement, insurance integration, and differentiated service models.

Original authors: da he, yichun gu, huiyun yang, botao tian, xin yang, shengyong jin, feng dong

Published 2026-07-13

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: da he, yichun gu, huiyun yang, botao tian, xin yang, shengyong jin, feng dong

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine you are a cancer patient trying to decide how to get your next check-up. You have two paths: the old-school way, where you travel to a big hospital, wait in long lines, and risk getting sick from germs in the waiting room; or the new-school way, using telemedicine, where you talk to a doctor from your couch. But here's the catch: not all "couch consultations" are created equal. Some are cheap but run by junior doctors with bad reviews; others are pricey but feature top-tier experts with glowing ratings.

A team of researchers decided to play a giant game of "What would you choose?" with 807 cancer patients across China. They didn't just ask, "Do you like telemedicine?" Instead, they set up a Discrete Choice Experiment—think of it as a video game menu where patients had to pick between two different "service bundles" that varied in price, doctor title, and features. By analyzing thousands of these choices, the researchers uncovered exactly what makes patients click "Accept."

The Big Reveal: Price is King, but Reputation is Queen

The study found that the single most powerful factor influencing a patient's choice is Out-of-Pocket (OOP) cost. In plain English: if the bill is too high, patients walk away. The data showed that patients are incredibly sensitive to price; the higher the cost, the less likely they are to choose the service.

However, once the price is on the table, reputation becomes the star of the show. The researchers discovered that patients care more about a doctor's patient ratings than almost anything else. If a doctor has "favorable" ratings (meaning patients say they are great at communicating and treating), patients are willing to pay an extra RMB 612.796 per visit just to see them. That's a huge chunk of change!

Next in line is the doctor's title. Patients trust the "Chief Physicians" (the bosses of the medical world) the most. They are willing to pay an extra RMB 370.287 to see a Chief Physician compared to a standard "Attending Physician." Associate Chief Physicians are also popular, commanding an extra RMB 194.382.

The "Vibe" Check: Audio vs. Video

Here is a twist that might surprise you. When it comes to how you talk to the doctor, audio (just voice) is the clear winner. Patients preferred voice calls over text or images, and they were willing to pay an extra RMB 126.799 for it.

But what about video? The study suggests that video didn't make a statistically significant difference for the average patient. In fact, many patients seemed hesitant about it, likely because they worried about privacy or didn't want their face or home environment on screen. The only group that really wanted video? High-income patients, who were willing to pay an extra RMB 468.139 for it. They seem to value the ability for the doctor to see their facial expressions to make a more accurate diagnosis.

The "Must-Have" Features

The researchers also tested out specific digital features, like:

Simple interfaces: A user-friendly app that isn't confusing. (Worth an extra RMB 92.766).
Access to records: Being able to see your test results and medical history online. (Worth an extra RMB 119.956).
Smart alerts: A system that uploads your home health data (like blood pressure) and warns you if something is weird. (Worth an extra RMB 85.201).

Interestingly, the "smart alerts" were the least important feature. The authors suggest this might be because too many automated warnings can actually make patients anxious or feel like the system is crying wolf.

The Ultimate "Dream Bundle"

The researchers ran simulations to see what would happen if they combined all the best features. They found that no single feature is a magic bullet. Instead, patients want the whole package.

In their simulation, the most popular scenario was a bundle that included:

A reasonable price (set at RMB 200 for the simulation).
A simple, easy-to-use app.
An Associate Chief Physician.
Access to medical records.
Audio consultation.
Smart health alerts.
A doctor with "favorable" ratings.

When all these stars aligned, the probability of a patient choosing telemedicine jumped to 89.33%. That is nearly 77 percentage points higher than the "worst-case scenario" (where the price was high, the doctor was unknown, and the app was clunky).

Who Wants What?

The study also looked at different groups of people and found some cool differences:

Older patients cared more about seeing a Chief Physician than younger patients did.
People in Western China cared the most about doctor ratings, willing to pay up to RMB 1,064.184 for a highly-rated doctor.
People who had never used telemedicine before cared most about seeing their test results online.
People who already used telemedicine cared most about the doctor's ratings.

The Bottom Line

The paper concludes that for telemedicine to really work for cancer patients, it can't just be a "cheap" alternative. It needs to be a high-quality, high-trust experience. The authors suggest that hospitals should focus on getting their best doctors online, making sure the apps are easy to use, and, crucially, making sure health insurance covers these services so the price isn't a barrier.

While the study is based on simulations and patient choices in a survey (not a long-term real-world trial), the results are a strong signal: if you want cancer patients to use telemedicine, give them a simple app, a top-rated doctor, and a price they can afford.

Technical Summary: A Study on the Preferences of Chinese Cancer Patients Regarding Telemedicine from a Demand Perspective

Problem Statement
Cancer imposes a significant and escalating burden on the global and Chinese healthcare systems, characterized by high incidence rates, complex treatment trajectories, and the need for long-term follow-up. In China, the centralization of oncology expertise in tertiary hospitals creates barriers for patients, including travel burdens, appointment difficulties, and infection risks associated with in-person visits. While telemedicine offers a potential solution to improve accessibility and continuity of care, its adoption among cancer patients remains limited. Challenges include patient concerns regarding safety, standardization, privacy, and the lack of integration with health insurance reimbursement systems. Existing literature has largely focused on government or institutional perspectives, or general telemedicine satisfaction, leaving a gap in understanding the specific preference structures and choice mechanisms of cancer patients regarding telemedicine service attributes.

Methodology
This study employed a Discrete Choice Experiment (DCE) to quantitatively analyze the preferences of Chinese cancer patients for telemedicine services.

Study Design: A D-efficient experimental design was generated using SAS 9.4 to create choice sets. The experiment involved seven key attributes identified through literature review and iterative expert consultation (using Best–Worst Scaling):
1. Out-of-pocket (OOP) cost (4 levels).
2. Platform usability (2 levels: simple vs. complex).
3. Physician's professional title (3 levels: attending, associate chief, chief).
4. Consultation modality (3 levels: text/image, audio, video).
5. Access to Electronic Medical Records (EMRs) and test results (2 levels).
6. Home-monitoring data upload with abnormal value alerts (2 levels).
7. Patient ratings of physicians (2 levels: favorable vs. unfavorable).
Data Collection: A stratified sampling approach was used to recruit 807 valid cancer patients from outpatient clinics at nine tertiary public hospitals across eastern, central, and western China. Data were collected via face-to-face surveys (paper or electronic) between July and December 2025.
Statistical Analysis: Data were analyzed using a mixed logit model in Stata 16.1, which was selected over the conditional logit model based on superior goodness-of-fit statistics (log-likelihood, AIC, BIC). The analysis included the calculation of relative importance scores (RIS), Willingness-to-Pay (WTP) estimates, subgroup analyses across sociodemographic and clinical characteristics, and scenario simulations to predict choice probabilities.

Key Results

Attribute Importance: Out-of-pocket (OOP) cost was the most influential attribute (Relative Importance Score: 41.28%), indicating high price sensitivity. Among non-price factors, patient ratings (25.56%) and physician title (15.44%) were the most significant determinants.
Preference Directions:
- Patients significantly preferred services with favorable patient ratings ( $\beta=0.6407, p<0.001$ ).
- There was a strong preference for chief physicians ( $\beta=0.3871$ ) and associate chief physicians ( $\beta=0.2032$ ) over attending physicians.
- Audio consultations were preferred over text/image ( $\beta=0.1325$ ), while video consultations did not show statistical significance in the full sample, potentially due to privacy concerns.
- Access to EMRs/test results, simplified user interfaces, and abnormal value alerts all showed positive, significant coefficients.
Willingness-to-Pay (WTP):
- The highest WTP was for improving patient ratings from unfavorable to favorable (RMB 612.796).
- Patients were willing to pay an additional RMB 370.287 for chief physicians and RMB 194.382 for associate chief physicians.
- WTP for audio consultation was RMB 126.799.
Subgroup Heterogeneity:
- High-income patients demonstrated a distinct and strong WTP for video consultations (RMB 468.139), differing from the general sample.
- Older patients showed higher WTP for chief physicians compared to younger patients.
- Western region patients placed the highest value on favorable patient ratings (WTP up to RMB 1,064.184).
- Patients with prior telemedicine experience valued good ratings more, while non-users prioritized access to diagnostic results.
Scenario Simulation: The highest predicted probability of choosing telemedicine (89.33%) occurred when all optimal attributes were combined (OOP cost of RMB 200, simplified interface, associate chief physician, EMR access, audio consultation, abnormal alerts, and favorable ratings). This was significantly higher than any single-attribute improvement.

Significance and Claims
The authors claim this study provides robust empirical evidence to inform the optimization of telemedicine delivery by tertiary public hospitals in China. Key contributions include:

Demand-Side Insight: It systematically identifies the specific attributes driving cancer patients' demand for telemedicine, filling a gap in the literature regarding this specific patient population.
Policy Guidance: The findings suggest that telemedicine development should be anchored in oncology specialty or tertiary hospitals, prioritizing the engagement of high-quality physicians. The study explicitly recommends that medical services and medications delivered via telemedicine should be progressively incorporated into health insurance reimbursement schemes to reduce OOP costs and facilitate expansion.
Service Design: The study advocates for differentiated service models to meet heterogeneous needs (e.g., video options for high-income groups, simplified interfaces for the elderly) and emphasizes that a bundled service approach (combining multiple optimal attributes) is more effective than optimizing single features in isolation.
Strategic Alignment: The results are presented as a contribution to the "Internet + Healthcare" framework and the "Healthy China" initiative, aiming to enhance patient acceptance and the standardized application of telemedicine in oncology care.

The authors acknowledge limitations, including the predominance of urban tertiary hospital patients in the sample, the exclusion of platform-based internet hospitals (focusing only on hospital-based ones), and the inherent gap between stated preferences in hypothetical scenarios and actual behavioral decisions. They suggest future research should include longitudinal studies and qualitative interviews in real-world settings.