J Am Med Inform Assoc 12:530-536 doi:10.1197/jamia.M1778
  • The Practice of Informatics
  • Application of Information Technology

Effect of an Internet-Based System for Doctor-Patient Communication on Health Care Spending

  1. Laurence Baker,
  2. Jeffrey Rideout,
  3. Paul Gertler,
  4. Kristiana Raube
  1. Affiliations of the authors: Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA (LB); National Bureau of Economic Research, Cambridge, MA (LB, PG); Cisco Systems (formerly Blue Shield of California), San Francisco, CA (JR); Haas School of Business, University of California, Berkeley, CA (PG, KR)
  1. Correspondence and reprints: Laurence Baker, PhD, Department of Health Research and Policy, HRP Redwood Building, Room 110, Stanford University School of Medicine, Stanford, CA 94305-5405; e-mail: <laurence.baker{at}>
  • Received 20 December 2004
  • Accepted 28 April 2005


We studied the effect of a structured electronic communication service on health care spending, comparing doctor office and laboratory spending for a group of patients before and after the service became available to them relative to changes in a control group. In the treatment group, doctor office spending and laboratory spending fell in the period after the service became available, relative to the control group (p < 0.05). A rough estimate is that average doctor office spending per treatment group member per month fell $1.71 after availability of the service, and laboratory spending fell roughly $0.12. Spending associated with use of the electronic service was $0.29 per member per month. We conclude that use of structured electronic visits can reduce health care spending.


  • The initial research underlying this manuscript was supported by the RelayHealth Corporation. The authors are grateful for support from Blue Shield of California in obtaining the data necessary for this study. They also acknowledge research support from Tiago Ribeiro of UC Berkeley and from Bruce Deal and Armando Levy of Analysis Group, Inc.

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