Why online shopping is more accessible than health care

I recently met people with motor impairments to do user research. To my surprise, they turned out to prefer online shopping sites to public health care sites. This in Sweden, a country at the forefront of technology and with supposedly the best health care in the world. Is this really possible?

Doctor's hands typing on laptop. Photo.

Who are these people?

I was doing user research on motor impairments in order to create a realistic motor impairment simulator. I’m in a super exciting project where we’re creating a browser plugin that simulates different impairments, like motor, vision, reading and cognition. I’ve added a link at the end of this article if you want to check out the plugin.

Anyway, the people I met had Reumatism, Parkinson’s, Arthritis or some combination of the above. Most, but not all, were senior citizens.

Online shopping versus health care sites

I asked them to give some examples of sites they liked and disliked, and then explain what it was about the sites that made them pleasant or difficult.

To my surprise, most people said they liked different e-commerce sites where you can buy clothes, tickets, books and similar items. When asked to give examples of sites that they didn’t like, the same site kept popping up: Sweden’s hub for health care 1177.se.

This blew my mind a bit. Is it really possible that online shopping is more accessible than health care sites?

What shopping sites do well

I love filling out forms
– No one ever

Forms suck. The longer the form, the greater the risk of making a mistake. And for many people with disabilities, inputting data takes longer and more mistakes are made. Stephen Hawking for example, types around two words per minute using his assistive technology. So it’ll take him, and many other assistive technology users, at least ten times as long to fill in a form than for most people.

E-commerce sites tend to put a lot of energy on making their forms easy to use. Health care? Not so much.

When buying books online, I simply enter my social security number in the checkout and all other form fields get prefilled. It’s super easy! When booking health care, it’s a complete mess.
– Woman with Rheumatism

She went on to explain different rules concerning which clinic she is allowed to pick, how most clinics have different routines for bookings, how she has to fill out information about her condition from scratch at each place she goes. The list went on. And on. And on.

Most users really dislike forms.
Most users with disabilities really hate them.

So to make your site accessible to people with disabilities you should focus on simplifying your forms. Amazon has taken form-simplification to the extremes with their “buy-with-one-click” checkout process (maybe they’ve even taken it too far).

Button, "Buy now with 1-click"

Compare that to the form for booking a time with the health care system below. Lots of fields in a cluttered layout. I know it’s in Swedish, but you get the point (sidenote: it doesn’t seem to be possible to get it in English, another big accessibility problem).

Form for booking health care. Screenshot, swedish.

Just the fact that you’re supposed to pick the times you can’t go to the clinic…wow. Imagine the number of mistakes made there.

I just want to talk to someone

Another person complained about how the health care system these days want everything to be done online and what a big a pain it is to get to talk to someone.

If you don’t call right when they open the phone lines in the morning, you can spend the whole day in a queue, and sometimes not get through before they close.
– Woman with Arthritis

The last couple of years more and more effort has been put into forcing users to the web interface. Giving people the opportunity to make a phone call is a service that costs too much, so the health care system is making it a hustle in hopes that people will do everything online instead. This is not appreciated by many people, especially by some elderly who are not comfortable with new technologies.

Choice is a key to accessibility. Give people the choice of which channel suits them best. Phone or web. That’s user centered design and client focused health care in practice.

So to summarize this section: contacting health care seems to be difficult, time consuming and a form fiesta.

Disabilities amplify usability issues

I’m pretty sure that if we’d check the accessibility standards conformance of all e-commerce and all health care sites, health care would win big time. But accessibility is so much more than conforming to accessibility standards.

Accessibility is mostly about issues that are not black or white.
Accessibility is mostly about “softer” things that are hard to put in a checklist or standard.
Accessibility is mostly about usability.

When most people in the IT sector think about accessibility, they think about coding and other techy things.

I’ve done hundreds of user tests with people with disabilities, and a majority of the problems that affect these users are not tech issues. Of course, making your site accessible for assistive technologies like screen readers is important. But most accessibility problems are usability related and affect all users.

But, one thing is really important to understand: usability problems are usually amplified by a disability. For example, finding the right country in a dropdown with 200 countries is irritating for everyone. But imagine your hand shakes constantly, your vision is blurry or you have dyslexia. The irritation is amplified.

Country dropdown. Screenshot.

So improving the usability of your interface is important for everyone. But it is crucial for users with disabilities.

It’s all ’bout the money

I believe that the main reason e-commerce sites often are better at usability – and thereby accessibility – is that they have a greater incentive to convert the users on their site into paying customers. They measure conversion rates and know the effect that simplifying form fields in the checkout has on conversion.

Health care obviously also care about money. But for them, it’s often measured in time spent by the health care employees. Phone calls take a lot of time, which costs money. So they have an incentive to reduce that time.

They end up hiding their contact info like a squirrel hides an acorn.

Squirrel with acorn. Photo.

And patients generally don’t have much choice. It’s not like if the site is a pain to use they’ll skip getting treated. And there is often no where else to go. It’s not like shopping, where you just can head over to a different store.

So users use the site even though it’s frustrating. Or sit for hours waiting to talk to someone who can help them.

Health care – time to shape up

Don’t get me wrong. Online shopping sites – like basically all sites out there – have their fair share of accessibility issues as well. But they prioritize user experience, and that pays off.

The health care sector, and the public sector in general, need to get better at user experience and put less of a burden on their users. User experience and user testing should be prioritized higher.

Because getting good health care should be just as easy as shopping online. Anything short of that is an embarrassment for a democratic society.

Check out the simulator plugin

Like I promised at the start of this post, here’s the link to the plugin that simulates different disabilities, if you’d like to check it out:


It’s in Beta right now but will be released sometime in the fall of 2017.

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