Abstract
BackgroundGift giving from patients to physicians, which is prohibited in traditional clinical settings in China, has been found to occur in online health communities. However, there is debate on the validity of online gifts since physicians gain an economic benefit. Moreover, the potential impact of these gifts, particularly with respect to the financial value of the gift, on the online consultation service quality remains unexplored.ObjectiveThe aim of this study was to explore the impact of gift price on the quality of physicians’ online consultation service. Insight into this impact is expected to help resolve existing debate on the appropriateness of the gift-giving practice in online consultations.MethodsA dataset of 141 physicians and 4249 physician-patient interactions was collected from the Good Physician Online website, which is the largest online consultation platform in China. Based on social exchange theory, we investigated how gift price affects the quality of physicians’ online consultation service and how this impact changes according to the physician’s service price and number of all gifts received. Manual annotation was used to identify the information support paragraphs and emotional support paragraphs in the answers of physicians. The quality of the information support paragraphs, rather than the complete answer, was used to test the robustness of our model.ResultsGift price had a positive impact on the quality of physicians’ online consultation service (β=4.941, P<.01). This impact was negatively mediated by both the physician’s service price (β=–9.245, P<.001) and the total number of gifts they received (β=–5.080, P<.001).ConclusionsGift price has a positive impact on physicians’ online behavior, although the impact varies among physicians.
Highlights
Gift exchange, including giving, receiving, and reciprocating, is generally defined as the circulation of goods to promote ties and bonds between individuals [1]
Some patients consider that online gift giving in online health communities represents a form of extortion with a bribe to a certain degree [5,6], whereas users of some online platforms regard it as a form of respect by acknowledging the knowledge labor of physicians [7]
The results showed a correlation between gift price and the quality of physicians’ online consultation service
Summary
Background Gift exchange, including giving, receiving, and reciprocating, is generally defined as the circulation of goods to promote ties and bonds between individuals [1]. Gifts exchanged between physicians and patients have been viewed as a form of illegal and unethical payment [3], which can potentially weaken the trust and deteriorate these relationships [4]. 70% of physicians stated that online gift giving is reasonable, 25% stated that it may make people uncomfortable, and 3% disapproved of this practice overall [7] The root of these debates is the possible impact of the financial value of the gift on the quality of physicians’ online consultation service, which remains unclear. The potential impact of these gifts, with respect to the financial value of the gift, on the online consultation service quality remains unexplored
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