Abstract
BackgroundMany markets have traditionally been dominated by a few best-selling products, and this is also the case for the health care industry. However, we do not know whether the market will be more or less concentrated when health care services are delivered online (known as E-consultation), nor do we know how to reduce the concentration of the E-consultation market.ObjectiveThe aim of this study was to investigate the concentration of the E-consultation market and how to reduce its concentration through information disclosure mechanisms (online reputation and self-representation).MethodsWe employed a secondary data econometric analysis using transaction data obtained from an E-consultation Website (haodf.com) for three diseases (infantile pneumonia, diabetes, and pancreatic cancer) from 2008 to 2015. We included 2439 doctors in the analysis.ResultsThe E-consultation market largely follows the 20/80 principle, namely that approximately 80% of orders are fulfilled by nearly 20% of doctors. This is much higher than the offline health care market. Meanwhile, the market served by doctors with strong online reputations (beta=0.207, P<.001) or strong online self-representation (beta=0.386, P<.001) is less concentrated.ConclusionsWhen health care services are delivered online, the market will be more concentrated (known as the “Superstar” effect), indicating poor service efficiency for society as a whole. To reduce market concentration, E-consultation websites should provide important design elements such as ratings of doctors (user feedback), articles contributed by doctors, and free consultation services (online representation). A possible and important way to reduce the market concentration of the E-consultation market is to accumulate enough highly rated or highly self-represented doctors.
Highlights
The Pareto principle states that, in many cases, approximately 80% of the effects result from 20% of the causes
E-consultation websites should provide important design elements such as ratings of doctors, articles contributed by doctors, and free consultation services
We propose the following hypothesis: H2: A market served by many doctors with strong online reputations is less concentrated than a market served by many doctors with poor online reputations
Summary
Background The Pareto principle ( known as the 80/20 rule) states that, in many cases, approximately 80% of the effects result from 20% of the causes. Market concentration or the Pareto principle may be an advantage in a business context (eg, in a supermarket or bookstore), but it is not good for the health care industry. A major concern for the health care industry is the limited service capability of each hospital or doctor; this is, not a problem in the product sales context. Many efforts have been made to decrease the concentration of the health care market by balancing supply and demand One example of such efforts is the role of family physicians in western countries, who make up a sizable portion of the primary care workforce [4]. A patient must see a family physician before seeing doctors at higher-level hospitals Another example is the hierarchical diagnosis and treatment system in China, an important part of China’s medical reform [5]. We do not know whether the market will be more or less concentrated when health care services are delivered online (known as E-consultation), nor do we know how to reduce the concentration of the E-consultation market
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