patients,physicians , and the interne t · 2013-07-25 · pharmaceutical companies. this implies...

PATIENTS, PHYSICIANS , AND THE INTERNE T

M Y T H, REALITY, AND IMPLICAT I O N S

JANUARY 2001

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The Boston Consulting Group is a management consulting firm widely regarded as the global leader inbusiness strategy. For 37 years, BCG has worked with companies in every major industrial and globalm a r ket to develop and implement strategies for competitive success. Founded in Boston in 1963, BCGnow operates in 32 countries and 47 cities around the world. For further information visit the BCG We bsite at www. b c g . c o m .

B C G’s Health Care practice serves all segments of the industry around the globe. Although a significantp o rtion of our work is with the world’s major pharmaceutical companies, we also assist e-health serv i c eproviders as well as genomics and biotech companies. In addition, we work with medical providerssuch as hospitals in academic medical centers, national health systems, and private and public insur-ers. Fi n a l l y, BCG assists the chemical divisions of our global life-sciences clients.

PATIENTS,PHYSICIANS,AND THE INTERNET

JANUARY 2001

www.bcg.com

MYTH, REALITY, AND IMPLICATIONS

Andreas Poensgen

Stefan Larsson

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© 2001 The Boston Consulting Group, Inc. All rights reserved.

For information or permission to reprint, please contact BCG at:E-mail: [email protected]: 617-973-1339, attention IMC/PermissionsMail: IMC/Permissions

The Boston Consulting Group, Inc.Exchange PlaceBoston, MA 02109

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PREFACE 5

IMPORTANCE OF THIS STUDY FOR HEALTH CARE PLAYERS 8

Pharmaceuticals: Opportunity for Market Leaders 8Health Insurance: The Need for Quick Action but a Long-Term Perspective 9Academic Medical Centers: A One-Time Branding Opportunity 9New Players: Special Sites, Connectivity, and Navigation 10

RESULTS OF THE RESEARCH 11

The Patient: Looking for Deep Content and Trustworthy Navigation 11The Physician: The Web Needs to Support the Workflow 15The Patient-Physician Relationship: The Internet Can Raise Its Quality 19

RULES FOR SUCCESS 22

Understanding Which Target Segments and Services Will Generate Value 22Reaching and Influencing Web Customers at Low Cost 22Converting Influence into Revenue 22The Economics Need to Be Understood by Disease 23Three Rules for a Successful E-Health Business 23

METHODOLOGY 24

T A B L E O F C O N T E N T S

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The first attempt to apply e-business to health care is over. Results have been disappointing, with failuresgreatly outnumbering successes. Most participants have either withdrawn or are working hard to adjust andrelaunch their concepts.

Our extensive discussions with clients and participants in the e-commerce market point to two conclusions.First, retail models for online services do not work well in health care. Second, how physicians and patientsbehave and relate to each other plays a huge role in the success or failure of e-health business concepts. Bothfactors have been poorly understood.

To separate myth from reality and determine the implications for e-health participants, BCG is conductingextensive market research on the quantitative and qualitative aspects of these issues. This publication sum-marizes results of a first study covering Sweden and Germany. Related research in the U.S. market is underway and will be reported separately later in 2001.

We value your comments on the substance of this report as well as your judgment on the importance of peri-odic updates and broader geographic coverage.

Philippe Guy Leader of BCG’s worldwide Health Care [email protected]

P R E F A C E

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A B O U T T H E A U T H O R S

Andreas PoensgenChilehaus AFischertwiete 220095 HamburgGermanyTelephone: +49 40 30 99 61 05Fax: +49 40 30 99 6350E-mail: [email protected]

Stefan LarssonHamngatan 211147 StockholmSwedenTelephone: +46 8 6145513Fax: +46 8 6115241E-mail: [email protected]

Andreas Poensgen is a vice president in the Hamburg office of The Boston Consulting Group. Stefan Larssonis a manager in the Stockholm office. Both have worked extensively in health care and helped clients addressthe impact of the Internet on the European health care market.

AcknowledgmentsWe would like to thank the team that carried out the analysis and compiled the results: Jens Baas (BCGDüsseldorf), Alexander von Bethmann and Sabine Hoener (BCG Munich); and Jens Deerberg-Wittram andBent Luengen (BCG Hamburg). All have made significant contributions to this project. We also gratefullyacknowledge the guidance and suggestions of Philippe Guy and Laurent Billés-Garabedian (BCG Paris);Richard Lesser (BCG New York); and Martin Silverstein, James Kent, and Deborah Lovich (BCG Boston). Wewould like to thank our editor, Bill Hampton, for his assistance in producing this report.

On behalf of The Boston Consulting Group, we wish to thank the more than 1,000 patients and 250 physi-cians in Germany and Sweden who participated in this research. Through questionnaires and focus groups,they provided crucial insight into the patient-physician relationship that lies at the core of the health careindustry.

Finally, we would like to acknowledge our clients. The long-term and trusting relationships we share havedeepened and enriched our understanding in myriad ways.

Andreas Poensgen Stefan Larsson

For Further Information Additional information about this research project is available from:

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The key decisions about health care are made bythe physician and the patient. Their relationshipand the choices they make about preventive care,diagnosis, treatment, hospitals, and other issueshave enormous influence on the business of healthcare.

BCG believes the Internet will have a very signifi-cant impact on the European health care systems,much of it determined by how the Internet influ-ences the patient-physician relationship. Theresearch described here focuses on this littleunderstood but profoundly important connection.

We conducted surveys involving 1,000 patients and 250 physicians—both Internet users andnonusers—and conducted 21 focus groups withInternet users in both Germany and Sweden. Wechose Germany because it is Europe’s largest healthcare market and Sweden because it is Europe’s mostInternet-savvy. Our objective was to discover howdoctors and patients perceive and might use theInternet, and how their actions will affect thepatient-physician relationship. Using what welearned, we identified strategic issues for develop-ers of e-health businesses.

Our research identifies clear implications for actorsin the e-health market:

P H A R M A C E U T I C A L S : O P P O R T U N I T Y F O R M A R K E T L E A D E R S

Pharmaceutical companies see the Internet as atool that can stimulate health awareness amongconsumers, presumably leading to earlier treatmentand higher medical compliance and thus to greaterdemand for pharmaceutical products.

Many pharmaceutical companies have investedheavily in Web sites. Their sites typically focus ondiseases and treatments for which they offer prod-ucts, ignoring alternatives. Our research indicatesthis strategy does not work.

Patients and doctors want information organized bydisease, with all treatment options. They expectcomprehensive information that answers all theirquestions. For Internet-based material, they wantlinks to related sites, including sites featuring peo-ple with the same disease or condition.

Most important, consumers and doctors want unbi-ased information associated with a credible brand.They trust data from university clinics and medicalsocieties but are skeptical of information frompharmaceutical companies. This implies that phar-maceutical companies will have a very difficult timesucceeding with their own Web pages.

We believe a better strategy is to partner with e-health players who carry a credible quality brand,such as a nationally recognized research institute oruniversity clinic. In many cases, the brand may havegreat potential but still need to be developed. Suchbrands tend to be country-specific, so an interna-tional player will need to forge partnerships withseveral online services. Pharmaceutical playersshould be prepared to offer full and unbiasedinformation.

This is a game that only the very largest pharma-ceutical players can win. Marginal suppliers will loseout. Because consumers want services organizedaccording to disease, pharmaceutical players mustadopt a product-specific strategy, carefully selectingwhich of their products to promote—and which notto—through the Internet.

I M P O R T A N C E O F T H I S S T U D Y F O R H E A L T H C A R E P L A Y E R S

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I N S U R E R S : T H E N E E D F O R Q U I C K A C T I O N B U T A L O N G - T E R M P E R S P E C T I V E

The Internet promises health insurance companieslower costs and greater marketing clout. But neither will be possible for a company that is slow to act.

Like pharmaceutical companies, insurers lackenough credibility among consumers and physi-cians to succeed as independent providers of in-depth health care information. A better strategy isto become a “navigator to quality.” This meansinsurers should help customers find the highest-quality e-health services rather than attempt to pro-vide those services themselves. The Internet can bea bewildering place for visitors, and our interviewsreveal the need for navigation assistance.

We believe insurers will need branded partners toprovide navigation services. Capitalizing on thisopportunity will require quick action, since mediacompanies, independent health portals, and otherscan be expected to go after the same market. Ifthese players succeed, insurers will lose an impor-tant opportunity to differentiate themselves.

Insurers can use the Web indirectly to reduce theircosts by influencing patient decisions that affectinsurance claims. Disease-management-based ser-vices will enable companies to help patients withpreventive measures, help them find the best careproviders for their problems, and ensure bettercompliance, thus minimizing long-term costs forboth treatment and sick leave.

This opportunity is no easy catch, however. Asnoted above, insurance companies, like the phar-maceutical industry, are not seen as credibleenough to be regarded as the primary guide in thehealth care space. Moreover, insurers could lose outto e-health businesses that serve the workflow ofphysicians and hospitals. Those businesses couldmake use of the data passing through their systemsto position themselves as “connectivity providers”that help physicians design more cost-effectivetreatment processes. Resulting savings would beshared primarily by the physician and patientrather than passed on to the insurance companies.

There is a time advantage for the most advancedinsurance companies wishing to occupy the diseasemanagement space. Ideally, others trying to devel-op connectivity services will turn to insurers as part-ners. The largest insurance players should seek towin a branding advantage by offering exclusive ser-vices, perhaps through partnerships with specialistWeb sites. Smaller insurance companies will proba-bly have to enter alliances to offer meaningful e-enabled care and management services.

A C A D E M I C M E D I C A L C E N T E R S : A O N E - T I M E B R A N D I N G O P P O R T U N I T Y

Our research reveals large and untapped brandingpotential for major health research institutes andacademic medical centers. Patients and physicianswe surveyed agree strongly that these organizationsare the most credible source of health information.Evidence shows that it will be extremely difficult forall other actors to fully satisfy consumers’ desire forinformation.

Patients want data and deep content on a specificdisease or condition. They search for specializedsites, which opens up an opportunity for specializedphysicians and clinical scientists. Research insti-tutes and academic medical centers are well posi-tioned to provide this information for patients andphysicians and to keep it updated in the face ofrapid increases in medical knowledge.

No major European players have yet emerged inthis field. The industry is largely characterized bypoor incentives for entrepreneurship, lack of astrong market mission, and an inability to invest inthe infrastructure necessary for a successfulInternet presence.

Yet the potential payoff could be large. Given theimportance of trusted sources of information, capi-talizing on an institution’s brand power in this areacould attract significant revenues. Handled cor-rectly, such exposure could strengthen the brandand indirectly attract new groups of patients,increase research grants from pharmaceutical andmedical technology companies, and help attractfirst-rate academics.

This opportunity exists only for the most presti-gious organizations. We recommend that playersestablish partnerships with pharmaceutical and/orinsurance companies to help fund their programs,and with leading patient-interest groups to enhancecredibility, brand awareness, and audience.

N E W P L A Y E R S : S P E C I A L S I T E S , C O N N E C T I V I T Y , A N D N A V I G A T I O N

Much opportunity in e-health rests with establishedplayers. This does not mean, however, that e-healthis exclusively a business for incumbents. There areopportunities for newcomers in:

• Specific disease-related services

• Other pharmaceutically oriented services: e-detailing, e-clinical trials, e-marketing data

• Physician-oriented services: practice supplies,training, e-detailing, e-clinical trials

E-Health PortalsThe first new players in the e-health field were por-tals providing general information on all healthtopics, primarily to patients. The barriers to entrywere low, and a large number were establishedthroughout Europe. Consumers feel oversuppliedwith free health information already, however, so tobe successful, an online portal must offer some-thing more. Attempting to provide in-depth infor-mation about all diseases is neither practical norcost effective. More focused sites offering the nec-essary depth, and backed by a prudent businessplan, will be major competition for the generalonline health portal.

Connectivity ProvidersThe complexity of medical information, coupledwith its volume and the increasing fragmentation of the health-care-provider service chain, offersgreat opportunity to improve communication andthus treatment and efficiency through Internet-based data transfer. Our discussions with patientsand physicians verified the business opportunity for players developing the infrastructure to boost medical and associated administrative information flows.

Physicians readily agree that improvements areoverdue. They also understand the Internet’s abil-ity to move data among otherwise incompatiblecomputer operating systems and software. Yet doc-tors hesitate to try new systems because of theirfamiliarity with current solutions, the time involvedin learning how to use new systems, and the conse-quences if systems fail. We believe the frustrationdoctors express about inefficiencies in data han-dling suggests they will adopt new tools step by step.

The strategic issues facing would-be players in e-health infrastructure services are daunting. Wesee significant short-term barriers for new players incapturing the physician’s attention. But we perceivethis to be a matter of inertia rather than deep-seated mistrust of the Internet. We are convincedthe key will be to approach the physician throughestablished players with whom doctors have trustingrelationships. Newcomers should be aware that thismarket is unlikely to develop quickly.

NavigatorsBesides the need for better information, thepatients we interviewed expressed a strong need forhelp with navigation. A few novel players are start-ing to develop offerings in this area. The need fornavigation services is growing with the increasingcomplexity of the health care market, for example,growing numbers of therapeutic alternatives. Andchanges in market structure, such as deregulationof public health care, allow the patient more free-dom in the choice of provider.

By using sophisticated tools to evaluate the qualityof care, navigators will assist patients in choosingamong providers and among therapeutic alterna-tives. For success, these tools must be scientificallysound and the navigator must be perceived as neutral and independent of the incumbents. In the largely publicly financed European health caresystems, the service is likely to be paid for not by the patient, but by the employer or another payerbenefiting from better quality of the care provided.

1 0

1 1

T H E P A T I E N T : L O O K I N G F O R D E E P C O N T E N T A N D T R U S T W O R T H Y N A V I G A T I O N

At the core of a patient’s connection to the healthcare system is the one-on-one relationship with hisor her doctor. Patients look for the same individu-alized attention when they visit an online healthcare provider. General information is insufficient.

There is no universal e-health consumer. Patientswant very focused and detailed information abouttheir specific condition or disease. They are notinterested in data about health care issues irrele-vant to their situation. Consequently, the e-healthmarket consists of a large number of sometimesvery specific segments, such as diabetes, breast can-cer, and pneumonia.

Segmentation extends beyond patients to includethe relatives and friends who care for them. Thislatter group represents a large adjunct market for e-health service providers. Nearly one-third of thepeople we interviewed say they have recently caredfor a severely sick person. We found their behaviorsimilar to that of the patient. This large segment ofpotential customers for e-health offerings is oftenoverlooked.

Patients are clear about what they want from theInternet (See Exhibit 1.):

• In-depth information and services organizedaround their particular health care interest

• Assurance that the data can be trusted

• Help finding specific information addressing theirpersonal needs

• Help selecting doctors and hospitals

• Very high security relating to their personal medical records

R E S U L T S O F T H E R E S E A R C H

E X H I B I T 1

What is most important for you?

P A T I E N T S W A N TR E C E N T F I N D I N G S A N D E X P E R T O P I N I O N

0% of interviewees 20 40 60 80 100

Latestresearch results

Expert advice

Backgroundinformation

Rating ofhospitals

In-depthinformation

Rating ofphysicians

Selection ofhospitals

Selection ofphysicians

52

42

40

39

38

38

34

34

What is not at all important for you?


Ability toorder wellness

products

Ability toorder pharma-

ceuticals

Common portalfor patients

and physicians

Links to otherhealth and

wellness issues

73

58

38

36

SOURCE: BCG research

1 2

General Search Engines, Not Portals, Are the Entry PointEuropean consumers usually start their quest foronline health information with a general searchengine such as Yahoo! rather than by going to a spe-cific health portal and searching from there. (SeeExhibit 2.) Their second choice is to enter thename of a disease directly into their Web browser(www.diabetes.com, for example) in hopes of find-ing an appropriate site.

E-Health Consumers Behave Differently Consumers who surf the Internet for entertainmentor amusement have no particular agenda in mind.They may be attracted to a Web site by its colorfullayouts and animated graphics. Consumers’ behav-ior is very different when the topic is health. Peopledo not visit health care sites randomly or for fun.Nor are they inclined to act on general health careinformation they find on the Web.

What Patients Say

“I only look up things on the Internet when I have a specific question.”

“I have little inclination to go to health-specific sites without reason.”

“There are simply more interesting things to do on the Internet.”

Their attitudes change sharply when an acute dis-ease strikes them or a relative. Suddenly they cravevery detailed, specific, and credible information.They choose their sources according to conserva-tive values: trust, quality, reliability, and loyalty.When they find a source they are comfortable with,they are willing to pay for the information. Theamount they will pay increases in step with theseverity of the disease.

E X H I B I T 2

What are the most important search methods?

S E A R C H E N G I N E S L E A D M O S T P A T I E N T S


Search enginessuch as “Yahoo!”

Special sites (e.g.,diabetes.de)

Health portal (e.g.,netdoktor.de)

Homepage of aparticular company

(e.g., pharma)

55

35

20

10


Consumers are not satisfied with either technique.The former approach usually generates a long listof possible sites but with very little, if any, attemptto evaluate their credibility. The latter method mayfail to produce any result at all.

Our research indicates many European consumersare not yet familiar with the health portal concept.Those who have tried health portals consider theinformation they find there broad and shallow. Ifthey are truly concerned about a health condition,consumers who start with a general health portalend up at a more specific and detailed site.

What Patients Say

“I always start with a general-purpose search machine such as Yahoo!…”

“What is a health care portal –is it comparable to these Webcrawlers or Yahoo!?”

Credibility Is Extremely ImportantA major issue for consumers is assessing the credi-bility of health care information they find on theInternet. When they make the decision to seekhealth data online, they want assurances that it isfactual and trustworthy.

DEEP CONTENT

www.Brustkrebs.de is a not-for-profit German medical content site

focusing on breast cancer. Patients get detailed information on

diagnostic procedures, therapies, and the experience of specialists,

as well as a breast cancer glossary. In addition, concerned patients

can get a second opinion on their diagnosis. The site offers

physicians a case collection, guidelines, and troubleshooting for

diagnostic problems. An interactive quiz for physician training will

be added in the future.

Almost four out of five patients we surveyed (78 per-cent) say they would use the Internet to get credi-ble, in-depth medical information. They look fornarrowly focused sites offering specific data.

This fundamental characteristic of the e-healthaudience has powerful implications. For the stand-alone e-health service provider, it underscores thesignificant difficulty of gaining consumers’ atten-tion and coaxing them to act. For sites hoping tosell health care information and services, it showsthe importance of assessing the market for data bydisease and then tracking site performance thesame way.

1 3

What Patients Say

“If my own doctor had told me, ‘Just take a look at the page www..., I would have done it!’”

“How can I be sure that I am getting a real expert’s information? Maybethere is just some kind of medical student sitting there…”

“It must be a well-known company or an organization that is trustworthy.”

Patients are specific about which sources of infor-mation they trust most. Universities and medicalassociations top their list, whereas commercialproviders and pharmaceutical companies carry theleast credibility. (See Exhibit 3.)

Consumers: A Difficult Source of RevenueConsumers have plentiful and free access to gener-al information about health, including some fromsources that offer high quality and credibility. Theysee no reason to pay much for medical information.(See Exhibit 4.)

E X H I B I T 3

U N I V E R S I T Y C L I N I C S A N D M E D I C A L A S S O C I A T I O N SA R E S E E N A S M O S T C R E D I B L E

Who would you trust and use as a source for information portals?


Group ofuniversity clinics

Medical association

University clinic

Governmentsick fund

Private healthinsurance

Pharmaceutical company

Commercial providers

80

72

69

58

40

25

25


Even so, European consumers show very little brandawareness in e-health. Loyalty to specific healthsites is low, and consumers rarely use bookmarks tomake it easy to return to a site. Marketing cam-paigns have failed to establish strong anchor pointsfor health-related questions, meaning that the racefor recognition in this sector is still wide open.

The German Centre for Cancer Research (Deutsches

Krebsforschungszentrum), a not-for-profit institution, has been

running a highly praised and much used information service by

telephone for the past 13 years. Recently it began to make available

a huge amount of information on its newly created Web site

(www.krebsinformation.de). Here patients, their relatives, and

physicians find information on cancer, its treatment, and the effects

the illness might have on their lives. The Web site registered more

than 60,000 hits in its first eight months of operation.

E X H I B I T 4

Would you pay for an information service?

M O S T P A T I E N T S A R E N O T R E A D Y T O P A Y M U C H F O R A N I N F O R M A T I O N S E R V I C E


Yes

No

No idea

66

24

10

If yes, how much are you willing to pay?


>100 €

51–100 €

26–50 €

10–25 €

<10 €

1

3

11

45

40


This attitude changes markedly if the consumerbecomes ill, and more so when the disease is severe.In this case, a patient’s interest in good informationspecific to his or her condition becomes almostinsatiable, and the willingness to pay increases withthe specificity of the data.

What Patients Say

“I wouldn’t pay for anything on the Web. My health insurance costs arehigh enough.”

“My health insurance should pay for the information I’m getting, sincethis might reduce the number of physician visits.”

“Perhaps I would pay as much for online information as for a paperback.”

1 4

The more specific the service provided, the morepatients are willing to spend. For example, 40 per-cent of patients are willing to pay between 10 and50 euros for one-time individual advice on whichhospital to choose. The precondition is that theinformation is specific to their individual situationand reliable.

Security for Data Is EssentialRegardless of the source of health care informa-tion, consumers are very concerned about securityon the Internet. The protection of their personaldata is essential to the success of any Internethealth care service. (See Exhibit 5.)

The first driver relates to the disease:

• Differences in behavior are governed by thenature of the disease or condition

• More severe diseases drive more intense Internetusage

• Desire for information declines for chronic dis-ease once the condition stabilizes

The second driver relates to patients’ perception oftheir doctors as authority figures:

• Some patients regard their doctors as sole andcomplete authorities. Others recognize that physi-cians may make mistakes

• Patients with chronic disease tend to take moreresponsibility for their health than those withshorter-term health problems

• Well-educated, middle-aged women lead allgroups in acceptance of responsibility for healthcare

• Self-confident patients are more likely than pas-sive patients to use information from the Internetto challenge their doctors’ advice or decisions

An initial comparison shows that physicians inEurope are less likely to be questioned than thosein the United States.

These characteristics can be used to categorizepatients in four groups—accepting, informed,involved, and in control—and show the effect ofInternet usage on patient attitudes toward thephysician. (See Exhibit 6.)

E X H I B I T 5

P A T I E N T S A R E A N X I O U S A B O U T M I S U S E O F F I N A N C I A L A N D O T H E R P R I V A T E D A T A

What are your concerns about using the Internet for health issues?


Misuse of data about financial

transactions

Misuse of data about own

online behavior

Misuse of own personal data

Damage of own computer

system

Identification ofonline-partners

80

71

67

62

45


F O U R D I S T I N C T S E G M E N T S O F P A T I E N T S A N D R E L A T I V E S E M E R G E D

E X H I B I T 6

God Partner/Consultant Supplier

Low

Moderate

High

Severity of condition

Perception of physician

Internet u

sage

Accepting

Informed

InvolvedIn control


Yet consumers realize tradeoffs must be made.These arise as patients seek increasingly specificinformation about their disease. They also arisewhen patients use the Internet to reach others withwhom they wish to discuss their condition. The bal-ance between needed security and needed informa-tion is highly personal and varies by patient accord-ing to the severity of the disease.

Patient Behavioral Patterns Are in FluxThe Internet is new to most consumers and its capa-bilities are evolving very quickly. Our researchsheds light not only on how consumers behavetoday, but on the two motivations likely to drivetheir behavior tomorrow.

1 5

Key questions are which segment(s) will expandand how fast. Our research suggests most patientsmove from “accepting” toward “in control” afterthey develop a serious disease or condition. This isthe moment they are most likely to seek informa-tion on the Internet. Once they are exposed to thecapabilities of the Web, they tend not to move backtoward the accepting segment.

We believe growing familiarity with and access to the Internet will draw more consumers towardthe in-control group over time. We expect the in-control and involved segments to experience thegreatest growth, with the involved group emergingas dominant in the long run. This evolution ofpatient behavior needs to be monitored as theinfluence of the Internet increases.

T H E P H Y S I C I A N : T H E W E B N E E D S T O S U P P O R T T H E W O R K F L O W

Physicians represent a very strong but difficult mar-ket for e-commerce services. Doctors understandthe potential of the Internet and are eager to use it.Yet they say they have very little time to learn how todo so.

About 75 percent of German physicians have acomputer in the office, according to studies ofGerman physician organizations, and about 47 per-cent of physicians are already using the Internetfrom their office or at home (Infratest).Consequently, physicians are a very strong potentialmarket for e-commerce services. But attracting doc-tors to online services has been difficult. We believethe key to tapping the potential lies in understand-ing the dynamics of a doctor’s daily workflow. Ourinterviews with physicians revealed:

• Doctors have two opportunities during their work-day to use the Web: when they are with patientsand after clinic hours when they do research orreview difficult cases. To date, Internet services forEuropean physicians have focused almost exclu-sively on after-hours time.

• The greater potential is to serve doctors when theyare seeing patients. But this requires a service thatprovides instant results. Doctors’ time withpatients is brief, and physicians will not wait for aservice that requires lengthy online searches ortime-consuming data downloads.

• Any offering needs to meet the strong securityconcerns of physicians.

• Doctors do not want to spend time learning newtechnologies. Penetrating this market requires ahigh sales investment. The best way to sell a doctoron a new service is to demonstrate it.

Physicians Demand High-Quality InformationLike consumers, physicians consider the Internet apotential source of useful health-related informa-tion. They also agree that the value of such datarelates directly to their depth, accuracy, and trust-worthiness. Like consumers, physicians consideruniversities the most reliable source of health careinformation.

Physicians do indicate strong interest in using theInternet as a source for expert medical informationand advice, and the potential ability to contactexperts to discuss difficult cases appeals to them.(See Exhibit 7.) They see themselves using the Webin this way primarily after clinic hours rather thanduring patient visits.

E X H I B I T 7

Which services would you like to have on the Web?

P H Y S I C I A N S A R E I N T E R E S T E D I N R E S E A R C H N E W S A N D E X P E R T A D V I C E


Latestresearch

news

In-depth health careinformation

Advice from experts

Basic health careinformation

Physician selection

Physician rankings

77

67

64

64

37

25


Physicians have a continuing need for high-qualityinformation about medical research related to theirspecific fields of interest. Many already useMedline, an established literature search service.They consider the Internet a viable alternativesource for such data. (See Exhibit 8.)

1 6

The doctors we surveyed say that during the daythey would be especially interested in services setup to assist in and support specific diagnoses, suchas online picture databases for dermatological diagnosis or ultrasound. To succeed, these services must:

• Be easy to use

• Display the requested information fast

• Be more than 99 percent reliable

• Overcome physicians’ skepticism about the advantage over other types of information services

What Physicians Say

“A personalized newsletter on specific medical information is useful; thecontent must be deep and rich.”

“I have checked pages from pharmaceutical companies, but I haven’tfound the information I was looking for.”

“Sometimes when I’ve had a really difficult case I’ve turned to a col-league in the U.S. for a second opinion.”

Physicians Need Online Training ServicesDoctors generally follow medical and researchdevelopments in their area of expertise. They do soboth privately and through formal training.Physicians spend money in both areas today(between 100 and 2,500 euros per year) and indi-cate they would be willing to use the Internet for atleast a portion of those activities.

A majority of our survey respondents say they wouldbe willing to use the Internet for certified training.Again, universities would be their most trustedsource. (See Exhibit 9.)

E X H I B I T 8

Would you use deep information at least occasionally?

D E T A I L E D D R U G I N F O R M A T I O N I S A N I N T E R E S T I N G O F F E R F O R D O C T O R S

0% of positive responses 20 40 60 80 100

Generalpractitioners

Specialists

94

83

Would it be advantageous to receive diagnosis-based introductions to new medications automatically?

0% of positive responses 20 40 60 80 100

Generalpractitioners

Specialists

65

45


How important for physicians is certified training via the Internet?

T R A I N I N G O F F E R SA N O P P O R T U N I T Y F O R N E U T R A L P L A Y E R S

E X H I B I T 9

% of interviewees 0 20 40 60 80 100

Not at allimportant

Not veryimportant

Ratherimportant

Definitelyimportant

5

26

41

28

Who should provide certified training on the Internet?


Group ofuniversity clinics

Physicians’association

Pharmaceuticalcompany

Governmentsick fund

80

71

34

17


Physicians’ Top Priority Is Web-EnabledCommunicationsCommunications within the health care industryare often archaic. Inefficiencies abound among—and sometimes within—such groups as generalpractitioners and specialists, hospitals, patients,insurance companies, laboratories, and pharmaceu-tical companies. Communications can be a majorissue for doctors when dealing with complex med-ical plans and payment systems.

Physicians are well aware of the problem. Theyexpressed strong views during our research, indi-cating that better communications would save time,avoid redundancies, reduce errors, accelerate theirdecision-making, and significantly improve theresponsiveness and quality of health care service.

1 7

In interviews, nearly all physicians offered unsolic-ited anecdotes about their frustrations in accessingall kinds of health data:

• Receiving diagnostic data too late

• Specialists not receiving any medical feedbackfrom a hospital to which they have referred apatient

• Difficulty reading handwritten notes from colleagues

• Limited access to patient histories when a diagno-sis has been made elsewhere

• Difficulty determining availability of hospital bedsor appointments with specialists

• Lengthy billing processes that make it difficult toassess the practice’s financial condition

What Physicians Say

“It would save enormous amounts of time and reduce wrong analyses ifwe could exchange data online.”

“I really would like to get all the treatment data from the hospital as soonas possible instead of waiting several weeks for a letter.”

“I think laboratory results, X-ray images, impressions of teeth, or derma-tologic pictures could be sent via the Internet.”

“Looking for X-rays is a major time waster.”

More than 60 percent of the doctors we interviewedwanted the Internet to help them find informationfaster. Half were interested in saving money, reduc-ing the complexity of administration, or exchang-ing data with colleagues. Nearly all responded veryactively to this subject, offering spontaneous exam-ples of where they thought the Internet could helpthem.

Physicians Welcome the Web as a Source ofAdditional RevenuesPhysicians are interested in exploiting businessopportunities presented by the Internet that do notconflict with ethical standards. These opportunitiesinclude participating in clinical trials and offeringadditional services to patients. Under very con-trolled conditions, they also would consider sellinggeneral information about trends, diagnostic andtreatment procedures, and cost-effectiveness toresearch companies that serve medical suppliers,pharmaceutical companies, and health insurers.

E-Procurement Is an Issue of Cost Savings Physicians in most European countries operate on afixed budget provided by sick funds and healthinsurance organizations. Their interest in new

sources of supplies for their practice is heavily dic-tated by price. They are intrigued by online supplysources, but they are not likely to use them unlessthey realize savings of at least 10 percent over tradi-tional sources. (See Exhibit 10.) This is truewhether they are shopping for specialized equip-ment or commodities such as syringes.

Savings that would motivate physicians to order practice supplies through the Internet.

S A V I N G S M U S T E X C E E D 1 0 P E R C E N T T O E N C O U R A G E O N L I N E

P U R C H A S E O F P R A C T I C E S U P P L I E S

E X H I B I T 1 0

0% of interviewees

Savings (%)

20 40 60 80 100

≤5%

6–10%

11–25%

>25%

5

20

49

26


Internet supply companies offer the potential forgreater selection. They can also command lowerwholesale prices because they can more easilyaggregate a larger base of customers than tradition-al bricks-and-mortar suppliers. But these servicesface significant difficulty overcoming physicians’comfort with sales representatives and the existingorder and delivery process.

What Physicians Say

“I fax them after clinic hours and call them during clinic hours. I thinkit’s very nice to be in touch with their salesmen.”

“If it is products you’re not familiar with, a good salesman will be a lotof help to you.”

“I’ll read their catalogue and then I’ll fax them an order and then thestuff will be outside my door.”

The barriers to entry in this market are strong butnot insurmountable. To be successful, players mustmake online purchasing easy to do.

What Physicians Say

“It would be nice to just enter an item and then get a list of all who sellit and their prices and freight charges.”

“It could be very helpful for standard products and frequently ordereditems.”

1 8

There Are Caveats: Time, Convenience, Security,and CostDoctors’ familiarity with technology and computersin general shapes how they perceive the Internet.Specialists already using high tech equipment intheir daily work are more receptive to Internet tech-nologies than are general practitioners.Entrepreneurial doctors—such as those runninglarge “health plants”—also are more likely to tryInternet services, perhaps because they are moreinclined to try new tools to make business opera-tions more efficient.

What Physicians Say

“During examinations I show the patient everything about iris diagnosticsfrom the Web.”

But even Internet-minded physicians temper theirenthusiasm:

• They worry about having to spend too much timelearning to access and use Web-based services

• They are not ready to change their existing IT systems to support Internet applications

• They are very concerned about the security ofpatient information and their own financial dataonline (See Exhibit 11.)

• Even when those requirements are met, they arewilling to pay for only a few types of Internet services

How quickly the Web will change physician behav-ior will probably be determined mostly by physi-cians’ views on their current practice managementsoftware(PMS). Physicians say they are reluctant tochange a functioning system even if a new oneoffers obvious advantages. (See Exhibit 12.) Theysimply cannot afford to risk system failure whilethey have patients waiting.

What Physicians Say

“I wouldn’t install new practice management software if you gave it to me.”

“I have MS-DOS, which at least doesn’t crash.”

“It would take half a year for my employees to learn to use it.”

“A system failure costs me so much time and money that I can’t affordany experiments.”

We believe several other factors will also influencethe rate of change. These include the rate at whichyounger and presumably more Web-oriented doc-

What are your most important security concerns?

P H Y S I C I A N S A R E R E L U C T A N T T O G O O N L I N E W H I L E S E E I N G P A T I E N T S F O R S E V E R A L R E A S O N S

E X H I B I T 1 1


Misuse of dataabout financial

transactions

Misuse of patient data

Misuse of dataabout your own online behavior

Damage to your computer system

88

79

75

69

Would you change your PMS if the new system had the following features?


Increased external security

Regular updates

Better functionalsecurity

Lower price

Integrated intranet access

Functional range

Improveduser friendliness

20

25

25

30

30

31

36


E X H I B I T 1 2

D O C T O R S A R E R E L U C T A N T T O C H A N G E I T S Y S T E M S

What are the most important hurdles to Internet usage?


Time consumption

Informationoverflow

Lack of trust

Cost

Languagebarriers

70

57

50

47

37


1 9

tors enter the profession, the rate at which practicesare merged, and the natural replacement cycle forIT equipment (expected to be around five years).Because most physicians have little time to educatethemselves on computer issues, the sales strength ofa provider is another factor to consider.

T H E P A T I E N T - P H Y S I C I A N R E L A T I O N S H I P : T H E I N T E R N E T C A N R A I S E I T S Q U A L I T Y

The patient-physician relationship has enormouseconomic impact on every facet of the health careindustry. Decisions regarding treatment and careultimately affect insurance costs, influence the for-tunes of drug companies and equipment suppliers,and determine the success of hospitals.

In the traditional patient-physician relationship,doctors monopolize information about diagnosisand the therapeutic alternatives, providers, andcost of treatment. Most patients accept this rela-tionship as normal. Patients also need emotionalsupport when diagnosed with a serious disease.Ideally, this support is provided by the physician.

What Patients Say

“It’s a matter of personal chemistry…”

“You want to look him in the eye…”

Yet surveys consistently show that patients are dis-satisfied with how little access they have to theirdoctors and how little time physicians have to

inform them about their condition and treatment.When patients and their relatives do not get theassurance they need, they turn to another doctorfor a second opinion. They also may contact patientinterest groups. The emergence of patient interestgroups for certain severe diseases such as cancerindicates both a willingness among patients to con-front their disease and an unmet need for medicalinformation and perspective.

The Internet has the potential to bring fundamen-tal change to the classic patient-physician relation-ship. BCG’s research focused on understanding thischange in terms of the life cycle of diseases. (SeeExhibit 13.)

Persuading Consumers to Seek Health ServicesWill Be a Challenge Convincing consumers to consider their health moreclosely and seek treatment sooner would have enor-mous impact on the businesses of wellness programsand pharmaceutical companies. Is the Internet thepowerful tool to open up this opportunity?

In many areas, the answer may be yes. People wantcompetent advice about a health issue that con-cerns them and might turn to the Internet to get it.But our research shows the connection betweenhaving a condition and acting on it is not alwaysobvious. Consumers may be aware of the potentialhealth risks of being overweight or smoking, forexample, but they are not likely to seek informationabout those issues.

E X H I B I T 1 3

B C G E X P L O R E D T H E I M P A C T O F T H E I N T E R N E T O N T H E P A T I E N T - P H Y S I C I A N R E L A T I O N S H I P W I T H T H I S F R A M E W O R K

DISEASE LIFE CYCLE

How do patients decide to seek medical advice?

Step 1

How do patients find a physician?

Step 2

How do patients and physicians make decisions during diagnosis, treatment, and recovery?

Step 3

QUESTIONS

• How do patients and physicians behave today and why?

• Are they using the Internet? How and why?

• For what would they use the Internet in the future? Why? How?

• Would they be willing to pay? For what? How much?

• What are the implications for health care players? Potential value generation? Overall market position?

2 0

Even consumers with greater interest in theirhealth are not moved to action by general healthinformation. Most people in this group will not visitan online health site without acute reason. This hasapparently widespread behavioral causes: manypeople act only when a crisis looms. But there arealso supply-side issues. Most interviewed remainedskeptical that Web-based information is any betterthan the flood of health information on radio ortelevision or in newspapers and journals.

We conclude that, in principle, large groups ofInternet users want to manage their health actively.(See Exhibit 14.) But designing a Web strategy thatinduces them to act will be difficult. The main chal-lenge is addressing this group at the right momentwith the right service package. The “point of sale”of an Internet service must be linked as closely aspossible to the recognition or diagnosis of a seriouscondition. Ideally, a physician recommends anInternet service tailored to the patient’s need.

and time-consuming process of asking friends andrelatives about their experiences. Our researchindicates clear interest in trustworthy informationabout a provider’s background and capabilities,quality record, and assessment by previous patients.

What Patients Say

“I’d like to have a list of specialists, with background information aboutthe doctors’ experience and training.”

Physicians strongly oppose Internet-based providerrankings, which challenge their traditional role asthe authority in medical matters. Rankings alsointroduce an element of competition within themedical profession, something European doctorsand other providers of health care have not beenexposed to in the past.

We believe growing demand by consumers, insur-ance companies, and other payer organizations willsoon bring ratings of doctors and hospitals to theInternet. This will have a dramatic effect on the wayhealth care providers view their patients. Withoutcompetition, patients are sometimes viewed as partof an inexhaustible supply of customers. As rank-ings become more prevalent, patients will becomecustomers who must be attracted and nurtured oneat a time.

Physicians who recognize this trend and adapt to it will be able to build higher-quality dialogue with their patients. A business opportunity exists fore-health players that can assist doctors in this transition.

Diagnosis and Treatment Will Be Enhanced by Better Relationships If the Web empowers consumers, how will it affectthe patient-physician relationship? Will patientshave a larger say or even a decision-making role in

Vitea is an Swedish Internet start-up that brokers health care serv-

ices. Its core customers are employers, and it is currently strictly

vertical in its focus on patients with musculoskeletal disorders.

Vitea helps employers analyze the health profile of the company and

identify employees who suffer from or are at risk of developing mus-

culoskeletal disorders. It uses proprietary tools to select high-per-

forming providers of care and match their capabilities to the needs

of the employees. Vitea also helps patients make appointments and

follows up to collect information on provider performance and

ensure patient compliance. Vitea’s client offering includes follow-up

on the impact of its services on the costs of the employer.

Which health issues are you concerned about?Would you like to get competent advice via the Web?


Muscular and skeletal

(e.g., back pain)

Dental issues

Dealing with stress

Depression

Diet

Quitting smoking

7958

7651

6038

3619

3621

3220

Importance of health issues Want help to find competent advice


E X H I B I T 1 4

P E O P L E A R E I N T E R E S T E D I N H E A L T H I S S U E S

The Internet Will Change How Patients Select Their ProvidersPatients are especially intrigued by the idea of usingthe Web to help them choose hospitals, clinics, anddoctors. Most do this now through an imprecise

2 1

diagnosis or treatment? Will patients routinely useinformation they find online to challenge theirphysicians’ opinions?

BCG’s research finds no reason to believe theInternet will empower patients to such a degreethat the patient-physician relationship is over-turned or destroyed. The physician will continue tobe the leader in health decisions for the foreseeablefuture. Yet our research indicates the Internet willalter the internal balance and, ultimately, the qual-ity of the patient-physician relationship:

• Patients diagnosed with serious diseases are wor-ried and emotionally distraught. They need car-ing, understanding, and assurance. The Internetwill have very little primary impact on the role ofthe physician here. The physician will remain themain source of emotional support, althoughpatient trust will be reduced if the physician failsto provide the detailed information patients want.

• Patients consider the Internet an additionalsource of health information, not a replacementfor the doctor. A physician’s recommendation stillcarries much more weight than anything patientsfind on the Web. Indeed, our consumer interviewsshow that many patients seek their physician’sjudgment on the quality of Internet information.

• Access to and use of information began to trans-form the patient-physician relationship evenbefore the Internet by making consumers betterinformed. The Web will accelerate this trend.

Our research suggests well-educated women aremost likely to lead the trend. It also indicates anincident of severe disease is very likely to draw thepatient, relatives, and friends to the Web.

The implication is that physicians must changetheir approach to patients. We believe doctors whounderstand this will establish a higher-quality inter-action with their patients that results in a strongpatient-physician bond, whereas doctors who rejectthe value of the Internet will eventually lose a por-tion of their patient base.

The Shortage of Physicians’ Time Creates a DilemmaMany physicians may find it difficult to adjust. Theyagree that the Internet can provide useful informa-tion. They also recognize the Web can open newchannels of dialogue between them and their

patients, such as e-mail, data exchanges, remotemonitoring, and joint access to patient medicalrecords.

The potential is there. But realizing it will not bequick or easy, because of the divergent needs ofpatients and doctors:

• Patients would like to e-mail questions to theirdoctors, but doctors doubt they would have timeto respond

• Physicians dislike the idea of patients schedulingappointments electronically, fearing they will loseownership of their own agendas

• Physicians feel uncomfortable about patientsbrowsing through their own medical recordsonline or questioning a diagnosis with informa-tion obtained from the Web

Many doctors consider connectivity with theirpatients through the Web a threat to their produc-tivity. They fear that the time required to discussissues with patients will reduce the number of peo-ple they can see and thus revenues at a time whenpressure on their earnings is rising.

Many physicians simply refuse to face these issues.Others recognize that responding to patientdemands constructively could generate additionaltraffic for the practice. But even these doctors areunwilling to pay others to help them communicatewith their patients, for example, by asking nurses toreply to patient e-mails.

It is this dilemma that creates the most uncertaintyabout the future of the patient-physician relation-ship. Where compromises are made there are alsopotential business opportunities.

Will physicians take the time to strengthen theirbond with patients? In many cases probably not, foreconomic reasons. Will physicians organize servicesto help them? Again, probably not. There is a busi-ness opportunity out there for those who can profitfrom influencing the decisions made within thepatient-physician relationship. As the study sug-gests, however, it will not be easy to shape and to realize.

The question is not whether the Internet will have afundamental and far-reaching effect on the healthcare industry. It will. The more difficult question iswhen. We believe the Web’s impact will be meas-ured over years, not months. Overcoming the iner-tia of the current health care infrastructure will bevery difficult. In many cases—going online withprescription services, for example—the pace will begoverned by legal and political considerations.

Nevertheless, we believe the Internet will changethe health care industry profoundly. Some effectsare being felt today. We recommend strongly that e-health players begin to formulate their Web strate-gies now.

But beware: many have failed and consumed mil-lions in funds in the process. Our research identi-fies four broad challenges actors will face:

• Understanding which target segments and whichservice mix will generate value

• Reaching and influencing Web customers at lowcost

• Converting influence into revenue

• Understanding the economics

U N D E R S T A N D I N G W H I C H T A R G E T S E G M E N T S A N D S E R V I C E S W I L L G E N E R A T E V A L U E

• Consumers have very different expectations forhealth-related Web services than for otherInternet services.

• There is no generic e-health consumer. Rather,there are many e-health consumers, whose behav-ior and interest are defined by their specific dis-ease or condition. Offerings must be data-rich“chimneys.”

• E-health services for physicians must be based ona clear understanding of their work habits and useof time.

R E A C H I N G A N D I N F L U E N C I N G W E B C U S T O M E R S A T L O W C O S T

• Successful e-health models need to win a signifi-cant and leading market share of the target group

• Many players have failed to build sufficientlystrong brand awareness at acceptable cost

• The oversupply of health information on the Webmakes it difficult to cut through and to win anaudience

• Actors must seek a competitive edge over otherofferings that gives them a lasting advantage

• For disease-specific offerings, the brand must sat-isfy consumer demand for medical credibility

• Products to increase connectivity must build onthe existing infrastructure

C O N V E R T I N G I N F L U E N C E I N T O R E V E N U E

• Direct revenue from patients and physicians oradvertising is not enough to support larger busi-ness models.

• The Internet could potentially unlock significantvalue justifying large revenue streams from foursources:

–pharmaceutical companies hoping to sell moredrugs

–insurance companies hoping to reduce the costsof care

–employers and social systems carrying the costsfor sick leave

R U L E S F O R S U C C E S S

2 2

2 3

–administrative costs to provide information andtransaction processing.

• At least for the first three sources, the beneficiar-ies are not party to the patient-physician relation-ship. They therefore cannot ensure a favorableoutcome directly. Only business models that solvethis dilemma will receive revenue from pharma-ceutical companies, insurance companies, oremployers.

T H E E C O N O M I C S N E E D T O B E U N D E R S T O O D B Y D I S E A S E

• Setting up deep “information chimneys” creates afixed cost for each disease

• Each disease offering requires a different set ofservices and consequently different resources (SeeExhibit 15.)

• Revenue streams are influenced by the prevalenceof a disease and the possibility of creating valuefor an involved player (See Exhibit 16.)

• Return on investment differs from disease to disease (See Exhibit 17.)

• Players should carefully scrutinize the economicsof the service portfolio

T H R E E R U L E S F O R A S U C C E S S F U L E - H E A L T H B U S I N E S S

• Formulating the correct strategy is more impor-tant than getting to market quickly with the latesttechnological features

• Features and technology can confer a temporarybut not a lasting competitive advantage

• Understanding health care economics, segmenta-tion, key success factors, and sources of competi-tive advantage is critical

We believe that following these rules is a key to success in the e-health space.

E X H I B I T 1 5

T H E C O S T E C O N O M I C S A R E D R I V E N B Y D I S E A S E , C O M P L E X I T Y , A N D I N N O V A T I O N

User

Costs

Variablecosts

Fixedcosts


E X H I B I T 1 6

R E V E N U E E C O N O M I C S D E P E N D O N P R E V A L E N C E A N D V A L U E P E R P A T I E N T

User

Revenues


E X H I B I T 1 7

E C O N O M I C O P P O R T U N I T I E S D I F F E R B Y D I S E A S E

NA B C D E F G H I J K L MDisease area

Return

+

–


Our objective was to gain a qualitative and quanti-tative understanding of the impact of the Interneton consumers’ and physicians’ behavior. We con-ducted 21 focus-group interviews with patients andphysicians in Germany and in Sweden. Thehypotheses generated were then tested in quantita-tive phone interviews.

For the focus-group interviews, we selected a rangeof health conditions and disease groups thatpatients and physicians might face:

• General acute health issues

• Chronic diseases

• Elective treatments

• Generally healthy patients with specific healthrisks

• Generally healthy patients with specific healthinterests

• Relatives taking care of sick family members

Our physician sample included general practition-ers, members of large practices, and specialists.

Our phone interviews of 1,000 randomly selectedpatients included 700 Internet users and 300 withno Internet experience. Half of the 250 physicianswe interviewed were Internet users.

The questionnaire for doctors and patients wasdesigned to reveal actual behavioral patterns andunderlying motivations at each stage in the pro-gression of a disease or condition:

• Still healthy/not yet diagnosed

• Searching for information

• Searching for providers

• Diagnosis, treatment, and recovery

• Support processes

M E T H O D O L O G Y

2 4

5

The Boston Consulting Group has published a series of

r e p o rts on e-commerce. It includes the following:

Mobile Commerce: Winning the On-Air Consumer

A report by The Boston Consulting Group, November 2000

The Business-to-Business Opportunity: Creating Advantage

Through E-Marketplaces

A report by The Boston Consulting Group, October 2000

Online Retailing in Latin America: Beyond the Storefront

A BCG report in partnership with Visa International, October 2000

(Available in English, Spanish, and Po r t u g u e s e )

Organising for E-Commerce: Global and Asia-Pacific Challenges

A BCG NetBizAsia strategy report, September 2000

The U.S. B2B E-Commerce Landscape Through 2004

A research bulletin by The Boston Consulting Group, September 2000

Racing Season: B2B E-Commerce in Germany

A report by The Boston Consulting Group, August 2000

(Available only in German)

Organizing for E-Commerce

A discussion paper by The Boston Consulting Group, April 2000

The State of Online Retailing 3.0

A Shop.org study by The Boston Consulting Group, April 2000

E - Tail of the Tiger: Retail E-Commerce in Asia-Pacific

A BCG NetBizAsia strategy report, March 2000

Winning the Online Consumer: Insights into Online Consumer Behavior

A report by The Boston Consulting Group, March 2000

The Race for Online Riches: E-Retailing in Europe

A report by The Boston Consulting Group, Fe b r u a ry 2000

For a complete list of BCG publications and information about

how to obtain copies, please visit our Web site at www. b c g . c o m .

www.bcg.com EC-R20-1/01

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