The Search for the Health and Social Security: Experiences from

Consumers Searching for Healthcare Services

Elorm Damalie

, Reima Suomi

, Pia Blomqvist

and Kaisa Ruotsalainen

Turku School of Economics, University of Turku, Rehtorinpellonkatu 3, 20500My, Turku, Finland

The Social Insurance Institution of Finland (Kela), Finland

Frantic, Finland

Keywords: Public Reporting, Information, eHealth, Literacy, Middlemen, Thematic, Systems.

Abstract: Backgroud and Objective: People use different information services to select their healthcare services. It is

important to collect and analyze user feedback from such sites to understand needs of the user and to develop

these services. As such information services are usually designed, implemented and maintained by third

parties, not the original service deliverers, we shortly discuss the concept of market middlemen. Furthermore,

as such services are not easy to use but require a certain level of experience and work from the users, we also

shortly review the discussion around eHealth literacy.

Study Design/Markets and Methods: Data was collected in year 2017 by the Contact Point for Cross-Border

Healthcare through a web-based survey from consumers searching for healthcare services. Some these

consumers are users of then Choosehealthcare.fi online service in Finnish Hoitopaikanvalinta.fi

website, that

now is renamed to EU-healthcare.fi and EU-terveydenhoito.fi in Finnish. Together feedback was collected from

93 respondents. We used thematic qualitative analysis to find themes that the respondents took up when

answering the survey. We used pre-analyzed material by Contact Point for Cross-Border Healthcare and Frantic.

Results: The results show that the needs of the users are very varied, and information on many different issues

are sought for. In general, the respondents found the amount of information to be overwhelming, and it was

difficult to find answers to specific questions. More structured information will give users an opportunity to

compare services between the different countries.

1 INTRODUCTION

The availability of information is more important now

than ever before. Consumer decision is now very

dependent on the amount of information available to

them. This is seen in amount of information

consumers are bombarded with daily by various

companies. In the healthcare sector, there is an

important need of availability of information to help

consumers make their healthcare choices (Wahlstedt

and Ekman, 2016). The internet is gradually

becoming the source of healthcare service-related

information (Parker and Plank, 2000, Lemire et al.,

2008). Searching for good reliable healthcare

information is gaining prominence among

consumers. This has led to the demand of platforms

that enables consumers to have access to the

https://orcid.org/0000-0001-5695-3415

https://orcid.org/0000-0003-2169-7997

information they search for in terms of healthcare.

There is the need of a platform that patients go to for

information about where to go for healthcare. The

norm is for consumers seeking information on

healthcare services turn to platforms with neither

comprehensive nor accurate information. There are a

number information sharing platforms available to

consumers to help them make healthcare choices. An

example of such a platform in existence in a number

of countries is the public reporting system.

Public reporting systems are platforms that

provide good and quality information to consumers.

Cacace (2012) defined public reporting as the

performance-related information about healthcare

and social service providers to the public in a

comparative approach. The goal of this is to give as

much information possible to affect the choices of the

consumer. It is considered as a strategy to stimulate

Damalie, E., Suomi, R., Blomqvist, P. and Ruotsalainen, K.

The Search for the Health and Social Security: Experiences from Consumers Searching for Healthcare Services.

DOI: 10.5220/0009795901030108

In Proceedings of the 6th Inter national Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2020), pages 103-108

ISBN: 978-989-758-420-6

103

improvement in quality and promote transparency

among providers. The fact is that, one of its benefits

is it gives very detailed information to the consumer

about the various healthcare service providers

available. It serves as a link between consumer and

service providers.

There are several factors that enhances usage of

public reporting systems as a source of information

for consumers. Presentation formats of information

and the quality of information enhances the usage of

public reports and eases the decision making of the

consumer (Faber et al., 2009). Public reporting

systems serve as middlemen between consumers and

service providers as they serve as a link between the

consumer and the service provider.

The search for health services demands

middlemen to make this easy and possible for all

parties involve. Yavaş (1994) defines the middlemen

as the third person in a trade off between a buyer and

a seller, he or she matches the buyer and the seller.

Middlemen serve as a link between the consumer

with a healthcare service delivery institutions. The

role of middlemen has been visible in the real estate

business and in the employment agencies. Hence this

article looks at middlemen role of EU-healthcare.fi as

a source of information to consumers and also as a

middleman between consumers and healthcare

service providers. Yavaş (1994) further states that the

search in any market is made thinner as the

middleman reduces the search intensities. According

to Biglaiser(1993) there are two most noticeable

reason for the middle man 1) they facilitate matching

in the market, in this context the healthcare market as

that is difficult for consumers and service providers

to meet on their own 2) the middleman also validates

quality of a service or product. There is a need for

middlemen in healthcare services. Different www-

sites serve as middlemen between service providers

and user in markets, including healthcare services.

Research has revealed that for consumers to fully

benefit from the use of healthcare services, they will

require some level of understanding of eHealth,

eHealth literacy and motivation.

e-Health is defined by Mitchell (1999) as a “new

term needed to describe the combined use of

electronic communication and information

technology in the health sector. The use in the health

sector of digital data –transmitted, stored and

retrieved electronically – for clinical, educational

and administrative purposes, both at the local site

and at a distance”. In 2001, Eysenbach gave a very

detailed definition of e-health as “an emerging field

in the intersection of medical informatics, public

health and business, referring to health services and

information delivered or enhanced through the

internet and related technologies. In a broader sense,

the term characterizes not only a technical

development, but also a state-of-mind, a way of

thinking, an attitude, and a commitment for

networked, global thinking, to improve health care

locally, regionally, and worldwide by using

information and communication technology”. From

the definitions, eHealth is a combination of a number

of areas of activity. For this article, the definition of

eHealth will be restricted to the definition by

Eysenbach. This definition highlights the need of

examining eHealth literacy.

eHealth literacy is defined by Norman and

Skinner (2006) as the “the ability to seek, find,

understand and appraise health information from

electronic sources and apply knowledge gained to

addressing or solving health problem”. This

definition takes into account the different skills set

needed to become an eHealth literate. The key aspects

of eHealth literacy can be listed as follows: traditional

literacy, health literacy, information literacy,

scientific literacy, media literacy, and computer

literacy (Norman and Skinner,2006). These are

further divided into two central types: analytic

(traditional, media, information) and context-specific

(computer, scientific, health) (Norman and

Skinner,2006). The level of eHealth literacy affects

the access, dissemination and assimilation of

information by the intended user. This also affects the

motivation of the intended user.

Motivation to use a system is a fundamental

reason to accept and use any health information

platform. According to Keller (2008) there are five

principles of motivation: attention is building the

curiosity and gaining the attention of the consumer by

using different approaches, the second is the

relevance of the content of the public reporting

systems, a consumer’s confidence motivates them to

use a public reporting systems and the satisfaction of

the consumer with their experience is important in

building a consumer’s motivation. The combination

of eHealth, eHealth literacy and intended consumer’s

motivation drives user engagement. Intended user’s

engagement enables the possibility of making choices

based on information about healthcare choices.

2 METHODS

For this research, a qualitative survey was conducted

to recognize the best means of offering information

on cross border healthcare to targeted audience on

EU-healthcare.fi.

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2.1 Participants

For this research, a qualitative survey was conducted

to recognize the best means of offering information

on cross border healthcare to targeted audience on

EU-healthcare.fi (previously Choosehealthcare.fi).

During the research, 93 participants were reached

through campaigns on Facebook and twitter and

additionally by sending an invitation to prior contacts

made on travel fair and other events. The age profile

of the respondents ranges from between 10 and 20

years old to over 70 years old. The age profile was

quite even in

 20 – 30 years old (15 persons)

 30 – 40 years old (13 persons)

 40 – 50 Years old (18 persons)

 50 – 60 years old (24 persons)

 60 – 70 years old (19 persons)

In addition to this, 4 respondents were over 70

years old and two respondents were under 20 years

old. Out of all the respondents 67 are working full

time, 18 are pensioners, 4 are students, 4 are

unemployed, 1 has a family related activity, 1 is on

leave and 1 has an informal career.

A significant share of the respondents resided in

Helsinki Metropolitan Region and the majority

represented Southern Finland. The northernmost

respondent was from Oulu. Two respondents out of

the 93 lived abroad.

The largest number (45) of respondent estimated

themselves to use healthcare services normally

approximately once every six months. A quarter (20)

of the respondents estimated themselves to use the

healthcare services approximately once every two

month. Out of the 93 respondents, 18 used healthcare

approximately once a year. Healthcare services were

used once a month by 6 respondents, 2 respondents

used more seldom healthcare services than listed

above and 2 used healthcare services often than all

respondents listed above.

2.2 Data Collection and Analysis

This section gives detailed account of how data was

collected and analysed.

2.2.1 Data Collection

Data was collected in year 2017 by the Contact Point

for Cross-Border Healthcare through a web-based

survey. As with qualitative survey research in general

is used to gain in-depth information about people’s

underlying reasoning and motivation. According to

Jasen, (2010), qualitative survey is used to study the

diversity of a topic within a given population. To

achieve this in this research open-ended survey

questions were asked to allow the respondents to

provide detailed answers. This allowed the

respondent to express what they felt about the topic

and provided exploratory data that revealed

unforeseen opportunities, quotes and issues. The

responses to these open-ended questions were used as

a basis for analysis, to develop and understand the

research questions.

2.2.2 Analysis

We used thematic qualitative analysis to find themes

that the respondents took up when answering the

survey. We used pre-analyzed material by Contact

Point for Cross-Border Healthcare and Frantic.

There are five phases that are inherent in

qualitative data analysis and these are compiling,

disassembling, reassembling, interpreting and

concluding (Yin 2011, 117). In relation to this, the

style of analysis used in this research was the

deductive thematic analysis. All answers from the

survey where combined and analysed using the six-

phase procedure suggested by Braun and Clarke,

2006 illustrated in Table 1.

Table 1: The six-step thematic analysis procedure (Barun

and Clarke, 2006).

Phase Procedure for each phase

1. Familiarization

with the data

Phase reading and rereading the data.

Immersion of self and becoming

familiar with the data.

2. Coding

Generation of codes that identify

important features that might be

relevant to answering the research

questions.

3. Generating

initial themes

Examining generated codes to identify

significant potential themes. Collating

all the data relevant to each potential

theme.

4. Reviewing

themes

Reviewing the potential themes against

the dataset, to make sure if the themes

that answer the research questions.

Themes are usually refined by

splitting, combining or discarding.

5. Defining and

naming themes

In this phase, there is the generation of

precise names for each theme and

detailed analysis of the themes.

6. Writing report

This phase begins with a fully defined

and named themes and involves the

final analysis to relate back the

research questions and writing of

report

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105

3 RESULTS

The results from the inductive thematic analysis are

presented here to describe respondent’s behaviour,

knowledge, desires and requirements for the search of

healthcare services. Using the data collected from the

qualitative survey, 20 raw data themes were

discovered relating to respondents experience,

knowledge and perception of healthcare and EU-

healthcare.fi. Following the identification of first

themes (n= 6-10) and after the reviewed themes (n=2-

4) three defined and named themes were identified:

information platform (website), type of information

and presentation of information. (See figure 2, 3, 4).

Figure 1: Respondents need for an information platform

(Website).

Information Platform (Website)

All the respondents stated or indicated the need for a

universal information platform(website),where they

could find all the information they are searching for

concerning healthcare services within Finland and

abroad. This finding is consistent with the literatures

on eHealth, public reporting and the need for

information. Out the respondents who responded to

the question of where they searched for information,

received and found information, 5 respondents stated

from a health center or a doctor, 23 respondents stated

from Kela, 26 responded from other officials and

experts, 24 respondents stated from internet forums

and 24 respondents responded nowhere. As the

respondents answered:

”From Kela’s services in international

healthcare”

”FB and other platforms in which patients [tell

that] they have ordered drugs from abroad”

”From friends”

”From insurance companies” or ” Insurance

companies’ websites”

”I went to kela”

”The internet”

”Industry publications and from magazines I deem

trustworthy”

“In the country visited”

”The reception staff at the hotel told me where to

go”

Furthermore, from the answers provided by the

respondent, the ease of finding information has been

a critical challenging issue. As other respondents

answered:

”From the husband’s place of work /

representatives of the international company”

”From a hospital in the country”

”The The Ministry of Foreign affair’s website”

”I got an address where to go from the hotel

reception”

”From the website of the Finland-Alanya

association”

”From country-specific websites”

Figure 2: Respondent’s thoughts on the type of information.

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Type of Information

The theme type of information is made up of

information, specific and different types. Most of the

respondent emphasized the difficulty in finding the

right information as stated:

”A lot! Concrete guidance is absent or confusing.”

The respondent further specified the things she was

looking for:

”Price. Availability. Insurance. What does

insurance cover?”

“From the information on the international Kela-

card”.

Majority of the respondents furthermore emphasized

their need of very specific information. One

respondent responded to the question was there

something that she or she could not find and the

response was ” Overall it was difficult to find

information on what kinds of care were available and

how the possible billing would work.” and also posed

the question ” How are medical visits paid, what kind

of treatment can I receive [in the foreign country]”.

This was the specific question she needs answer to

and has searched for information from travel

agencies. Lastly, one respondent expressed the

difficulty in recognizing medical products and was

searching for information from a pharmacy,

Facebook and forums. The respondent posted the

question:”Do I need a certificate for my medicine?”

Figure 3: Respondents need for good presentation of

information.

Presentation of Data

Presentation of data is important to the use of

information page. Information that is not presented

well is useless to the consumer as expressed by a

number of the respondents of the survey:

”It would be nice to receive information from a

single, clear website.”

”Concrete checklists on how to act”

”Prices, quality etc. [of the services], comparative

information”

Furthermore, some respondents which to have a

single page on the internet with all the information

they will need:

”Some kind of information page online”

”It would be nice to receive information from a

single, clear website.”

”Comprehensive information in a single place and

preferably some contact information to reach if no

answers are found.”

”There were some things on Kela’s website, but

the information came in crumbs and finding it was

not easy.”

A number of respondents also emphasized the

language of the information presented

”Compiled on a single website in plain Finnish.”

”On Finnish-language websites.”

Presentable information should be easy to understand

and located easily on the page. The ability of finding

information is increased if the information is

presented in good and useful way. The result of lack

of proper presentation of information is stated by one

respondent:” I did not really find information on what

to do if I got into an accident.” Information validity is

a matter of concern to respondents as mentioned by

one respondent:” A website with current information

on each country and its services”

4 CONCLUSIONS

The purpose of this research was to identify the

consumers need for information to support their

decisions on healthcare service. Information platform

(website), type of information and presentation of

information were the three main themes identified

from the data. The result from this research supports

the previous research on public reporting, eHealth,

eHealth literacy, middlemen and motivation.

According to the results, there is a strong link

between the three identified themes to the effective

use of information available to consumers on

healthcare service delivery.

As seen from the data, the need for an information

platform (website) is paramount to the successful

understanding and selection of healthcare services.

Public reporting systems are just an example of such

a platform. A platform that consumers can tend to

with certainty that they will find the information they

are looking for. The knowledge of the existence of an

The Search for the Health and Social Security: Experiences from Consumers Searching for Healthcare Services

107

information platform (website) by a consumer is a

source of motivation to use the information platform

to assist in decision making in terms of healthcare.

From the data is clear that consumers will like to use

Choosehealthcare.fi, in Finnish Hoitopaikanvalinta.fi

website, which is now renamed to EU-healthcare.fi.

The middlemen have a responsibility of defining

the type of information that are presented on the

information platform (website) for consumers. From

the data collected, consumers want specific, practical

and useful information. Furthermore, consumers

want more structured information that gives them the

opportunity to compare services in different

countries. This is a motivational source to use the

information platform (website). Comprehensive and

easy-to-follow information on the healthcare system

seems to be difficult to design. With a strong

understanding of eHealth and eHealth literacy,

information platform that caters to the needs of

consumers within Finland and abroad can be

achieved.

Presentation of information is essential to the

success of the information platform (website). From

the survey is clear some consumers were not happy

with the presentation of the information. Presentation

of information comprises of font size, the various

links on the page to other pages, clarity of the

information presented and easy navigation of the

website. The eHealth literacy level of consumers

affects how they access, disseminate and assimilate

information. Hence, can affect the motivation of a

consumer to use the information platform as was

noted in the data collected.

The results show that the European and health

service scene is rather scattered, non-standard and

difficult to understand. Comprehensive and easy-to-

follow information on the healthcare system seems to

be difficult to design. It was encouraging to see that

people with very different backgrounds had found the

service and used its services. Users also found the

www-site though very many different channels. It is

clear even from our study that there is a huge demand

for middlemen-services in healthcare service

delivery, but a lot has to be done to improve their

usability, including the improvement of people’s

health literacy, as well as their social literacy

Based on this study there should be further

research exploring the themes (information platform,

presentation of information, type of information) in

greater details to form a more solid understanding of

the challenges regarding the use of EU-healthcare.fi.

Also, subsequent research should aim to facilitate

eHealth literacy of consumers as this is the future of

healthcare service delivery. Furthermore, there

should be more research on the marketing and

popularization of the EU-healthcare.fi.

ACKNOWLEDGEMENTS

Contact Point for Cross-Border Healthcare and

Frantic carried out the survey and the pre analysis of

the collected data. The authors will like to thank them

for availability of the data.

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