No organisation wants to be stuck in a long contract when they appear to be paying over the odds, particularly when the technology is getting a bit long in the tooth. Telephony contracts of 7, or even 10 years, have been often unfair on the customer, particularly when an innocent addition of a new extension resets the clock back to the start.
So 'no commitment' arrangements can look like an appealing option. With these schemes, the customer buys some hardware - typically phones and a router - and 'only' pays ongoing call costs, maybe with a few predictable and perhaps some surprising extras.
But a contract is a two way agreement. A reputable supplier will also be committing to provide a level of service. This includes service availability, which is not an optional extra when dealing with patient calls. It also includes a support framework to ensure configuration changes for routine and emergency events can be made quickly without unpredictable costs. A 'self serve' portal is fine, and perhaps an essential feature of any system. But managing the system, or project managing the installation, is not the core competence of healthcare or administrative staff. With extended hours, a 24/7 manned support line is not a luxury extra.
It is worth also remembering that 'pay as you go' suppliers are not charitable organisations. They need to at least have the intention of making a profit, even if they do not invest so heavily in customer support infrastructure. So the charges become disguised and transaction costs unduly inflated. A recent comment from a surgery considering telephone triage said they thought the call costs would make it prohibitive. Another found it too expensive to call patients when prescriptions were ready. This is not a business model that drives patient care!
In the end, it is very much the buyer's decision. The Internet may provide some dubious claims, but there is much genuine user experience online worthy of consideration before choosing a supplier. References are the key. Consider a supplier's financial standing and collateral before entrusting them with patient calls. Remember the 'cost per copy' photocopier contracts that caused much scandal in the press over the last few years. And a final thought - would you be perhaps a little perturbed if the supplier of the IT behind a 999 contact centre charged on cost-per-call basis?