The Internet's challenge to health care provision

A free market in information will conflict with a controlled market in health care

The unprecedented growth of the Internet presents a defining moment at the end of the millennium.1 The information age, long predicted, seems at last to be upon us. Yet the speed of its arrival has left most of the medical profession ill prepared to participate in it and unable to foresee its consequences for clinical practice.

Through the Internet, the public has access to a growing supply of information on health and disease, often of variable quality and relevance.2 As a result, providing information on health will no longer be the exclusive remit of health care professionals. The quantity of information on the Internet will continue to grow over the next few years, as will the proportion of people with access to it. Access is already widespread in some populations. In 1994, 46% of patients in one Californian clinic had access to email, 89% of them through their place of work.3 In some areas, proportionately more patients than doctors will have access to the Internet.

Health care information on the Internet has potential major benefits for patients. Numerous electronic discussion groups already allow patients to share experiences and some health related Internet sites offer email advice on a fee for service basis. Other organisations, including the BMJ, provide free access …