Exploring Paths of Justice in the Digital Healthcare : A Socio-Legal Study of Swedish Online Doctors

Sammanfattning: Online doctor services, healthcare provided via smartphone apps, have gone from being peripheral to seriously challenging the conventional Swedish way of providing healthcare services. The accessibility of online doctors is unsurpassed but all patient groups have not gotten better access to healthcare thanks to online doctors.The aim of this study was to investigate how perceptions of the online doctor service Kry influence the willingness to use said service. This has been achieved through two online surveys conducted in 2016 and 2017, generating two study samples of 1,264 and 882 cases, respectively. Survey items operationalised perceptions of justice as well as benefits and risk beliefs associated with Kry. Statistical modelling was performed, applying PLS path analysis.Inspired by the meta-theoretical perspective of critical realism, the aim was also to explain the underlying mechanisms that cause online doctors as a Swedish healthcare phenomenon. This has been achieved through a descriptive analysis based on, for instance, legal documents, governmental reports, regional recommendations, statistics, and newspaper articles. The descriptive study has been guided by Alan Norrie’s sociology of law and the theoretical figure of law’sarchitectonic, where the legal is always also the ethico-legal, the juridico political, and the socio-legal.Results from the surveys and the subsequent statistical modelling showed that the willingness to use Kry was predicted by perceptions of distributive justice, i.e., whether the service was perceived as accessible and inclusive (equality), and whether it was perceived as providing value for time and money spent (equity). Furthermore, perceptions of equality and equity were mediated by perceptions of perceived trust and interest in Kry. Perceptions of procedural justice did not impact the willingness to use Kry to the same extent.The descriptive study showed that Swedish online doctors as a phenomenon has emerged in a health system shaped by ethico-legal, juridico-political, and what I call econo-legal conflicts. Swedish healthcare law is based on the principle stating that those in most need of care should receive care first and on the overarching goal stating that the healthcare should strive towards an equal healthcare for the entire population. With the free choice of care reform, implemented in 2010, the Swedish health system was transformed into a quasi market and the principle of demand, stating that the patient should receive healthcare when she demands it rather than when she needs it, has entered the health system under the label free choice. This ethical and normative ambivalence is found in and expressed through healthcare law.Unlike the health system at large, online doctors are well equipped for a healthcare that is becoming increasingly consumer-driven. This may explain why distributive justice predict the will to use Kry. Much like the online marketplaceexperience, patients are judging the online doctor experience based on value for time and money spent.