Impact of E-visits on Outpatient Volume and Service Time: Evidence from a Large Public Hospital in China

The emergence of electronic visits (e-visits) as a convenient, efficient alternative to in-person outpatient care has reshaped service delivery in large public hospitals in China. However, how this dual-channel outpatient model reshapes overall medical demand and clinicians' service patterns remains insufficiently understood. Drawing on real-world data from a large public hospital in China, this study systematically estimates the impacts of e-visits on outpatient volumes and clinicians' service time. The authors adopt a twofold difference-in-differences model employed for the analysis that accounts for heterogeneous effects across disease types, physician seniority levels, and external environmental factors, such as infectious disease outbreaks. The results show that e-visits adoption is associated with a 14% (P<0.001) overall increase in outpatient volume, a 16% (P<0.001) increase in aggregate service time, and a 32% (P<0.001) growth in average service time per patient for the full outpatient system. Conversely, the office channel records a 6% (P<0.05) reduction in visit volume and a 3% (P<0.1) decrease in service time. Mediation analysis further confirms that e-visits do not mitigate the coronavirus disease 2019 pandemic-driven decline in outpatient volume and exert only limited effects on average service duration. However, subgroup analyses reveal that patient demand shifts substantially toward senior physicians after the launch of e-visits, while junior physicians experience reduced patient inflows. Collectively, these findings verify a prominent channel substitution effect, whereby office outpatient demand is partially diverted to online channels, rather than driving uncontrolled overall demand growth. Nevertheless, without standardized time scheduling frameworks and systematic patient triage mechanisms for e-visits, two critical operational drawbacks emerge. First, the increase in clinicians' total service time may increase workload and increase the risks of occupational burnout. Second, concentrating patient flow on senior experts leaves junior doctors' service capacity underutilized. These insights provide actionable guidance for health care administrators to optimize e-visit service mechanisms, particularly by restructuring the unplanned, open-access online consultation entry for patients. Such policy adjustments help balance the distribution of online and offline outpatient flow, alleviate imbalanced physician workloads, and ensure the sustainable deployment of clinical human resources.