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In online medical consulting platforms, physicians can get both economic and social returns by offering online medical services, such as answering questions or sharing health care knowledge with patients. Physicians’ online prosocial behavior could bring many benefits to the health care industry. Monetary incentives could encourage physicians to engage more in online medical communities. However, little research has studied the impact of monetary incentives on physician prosocial behavior and the heterogeneity of this effect.
This study aims to explore the effects of monetary incentives on physician prosocial behavior and investigate the moderation effects of self-recognition and recognition from others of physician competence.
This study was a fixed-effect specification-regression model based on a difference-in-differences design with robust standard errors clustered at the physician level using monthly panel data. It included 26,543 physicians in 3851 hospitals over 133 months (November 2006-December 2017) from a leading online health care platform in China. We used the pricing strategy of physicians and satisfaction levels to measure their own and patients’ degree of recognition, respectively. Physicians’ prosocial behavior was measured by free services offered.
The introduction of monetary incentives had a positive effect on physician prosocial behavior (β=1.057,
This study explored the positive effect of the introduction of monetary incentives on physician prosocial behavior. We found this effect was enhanced for physicians with a high level of self-recognition and others’ recognition of their competence. We provide evidence of the effect of monetary incentives on physicians’ prosocial behaviors in the telemedicine markets and insight for relevant stakeholders into how to design an effective incentive mechanism to improve physicians’ prosocial engagements.
Online medical service platforms are growing rapidly. They have been viewed as an important supplement for the offline health care industry through medical resource allocation and physician-patient interaction [
There are still many challenges in the development of the online health care industry. First, choosing an appropriate physician is critical for online patients [
The introduction of monetary incentives may influence physicians’ prosocial behaviors through self-determination and image concerns [
Although physician online prosocial behavior has significance for online patients and society, there has been little research to explore it deeply. First, research on physician online prosocial behavior in telemedicine markets is scant. Previous research has been in a wide range of disciplines, such as economics [
Our study investigated the impact of monetary incentives on physicians’ prosocial behaviors based on self-determination and image concerns theories [
Self-determination theory details intrinsic motivation and extrinsic motivation [
Generally, prosocial behavior is defined as a contributors’ actions that benefit other people or society [
When making decisions, physicians would predict the outcomes of choosing different actions and may seek to draw lessons from consequences suffered both by themselves and others [
In telemedicine markets, patients usually communicate with physicians to obtain medical advice and professional treatment, and physicians contribute free feedback to patients to promote their online presence and image [
Self-determination theory proposes that human beings have basic psychological needs for autonomy, competence, and relatedness, and that satisfaction of these basic psychological needs provides the nutriments for intrinsic motivation and internalization of extrinsic motivation [
Toubia and Stephen [
The variance in the timing of monetary incentive appearance across physicians provides a unique quasi-experimental opportunity to estimate its influence on physician’s online prosocial behavior. With the entry of monetary incentives in a particular month as the treatment, physicians who had at least one entry were the treatment group (ie, physicians with incentive), and those without any entry were the control group (ie, physicians without incentive). We used a difference-in-differences (DID) approach to represent the quasi-experiment [
Research framework of the impact of introducing monetary incentives on physician online prosocial behavior.
This study collected data from a leading online health care platform called Haodf in China. The functions of the platform include online medical consultation, appointment referral, medical information inquiries, knowledge sharing of medical science, physician recommendations, and so forth. In addition, this platform offers a unique institutional setting to separate free and paid consultations. We identified a paid consultation service as a significant sign of payment as shown in
Physicians’ prosocial behaviors were the free consulting services offered by physicians in an online health care community, measured by the logged volume of free answers in a given month as the dependent variable. The introduction of online monetary incentives was the key independent variable of interest in our estimation.
To explore the heterogeneous effects of monetary incentives on physicians’ prosocial behavior, we introduced two streams of moderators, including high price and high rated. High price indicated the extent of physicians’ self-recognition measured by the pricing strategy of consulting established by physicians. High rated was the extent of others’ recognition of a physician measured by the online rating posted by patients. Several control variables were considered to ensure the model robustness; examples include patient votes, letters of thanks, affiliated hospital level, and professional title.
For a physician
where
Description of the paid consultation services.
Definitions and summary statistics of variables (N=777,110).
Variable | Definition | Mean (SD) | Range | |
Prosocial behavior | Logged number of free services offered by a physician in a given month | 1.600 (1.958) | 0-10.788 | |
Monetary incentive | Dummy variable indicating whether a physician started receiving actual monetary income in a given month | 0.307 (0.461) | 0-1.000 | |
High pricea | Dummy variable indicating whether the consulting price is high for a physician in online medical consulting platform | 0.279 (0.449) | 0-1 | |
High rateda | Dummy variable indicating whether a physician is high rated by the users in online medical consulting platform | 0.451 (0.498) | 0-1 | |
Patient votes | Logged number of votes showing praise given by patients to a physician | 2.815 (1.479) | 0-7.720 | |
Letters of thanks | Logged number of letters of thanks that a physician received in a given month | 0.162 (0.471) | 0-5.273 | |
High hospital levela | Dummy variable indicating whether a hospital is designated by the Chinese government as a “third-level grade-A” level | 0.765 (0.424) | 0-1 | |
Professional title | Official clinic title certified by the national agency with uniform standards; Four stages exist for clinic titles: archiater (4), associate archiater (3), chief physician (2), resident physician (1), and none (0). | 3.073 (0.886) | 1-4 |
aHigh price, high rated, and high hospital level are split by their mean values.
Statistical analysis of pairwise correlation of variables.
Variable | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
1. Prosocial behavior | — | |||||||
2. Monetary incentive | .461a | — | ||||||
3. Votes | .407a | .215a | — | |||||
4. Letters | .497a | .34a | .353a | — | ||||
5. High price | .195a | .106a | .446a | .175a | — | |||
6. Title | .035a | −.048a | .371a | .022a | .229a | — | ||
7. High rated | .214a | .127a | .603a | .222a | .350a | .246a | — | |
8. Hospital level | .010a | .016a | .168a | .037a | .108a | .100a | .207a | — |
a
We compared the intensity of physicians’ online prosocial behaviors before and after the introduction of monetary incentives. To illustrate the moderation effects of high price and high rated, we generated a set of plots using the physicians in our data who had experienced monetary incentives (ie, treatment physicians).
Model-free comparison of free services volume for physicians by (a) price setting and (b) rating.
We report the estimated effects of monetary incentives on physicians’ online prosocial behavior in
Although we controlled a set of observable attributes along with the physicians’ and time-fixed effects, a potential problem with our DID design was that physicians are different. A particular concern was that physicians who enrolled later may have been attracted by the introductory incentive policy, or there was a different trend that caused a selection bias in our estimation.
To check the robustness of our research model, we used matching methods to select similar physicians from our control and treatment groups to replicate the main analyses shown in
Estimation results of the impact of monetary incentives on physicians’ online prosocial behavior (N=777,110).a
Variable | Prosocial behavior | ||||
Ordinary least squares | Fixed effects | Self-recognition | Recognition from others | Combined model | |
Monetary incentive | 1.498b (0.019) | 1.057b (0.019) | 0.959b (0.022) | 0.876b (0.026) | 0.842b (0.026) |
Monetary incentive × high price | —c | — | 0.275b (0.037) | — | 0.188b (0.040) |
Monetary incentive × high rated | — | — | — | 0.325b (0.034) | 0.267b (0.036) |
Control variables | |||||
Letters | 1.259b (0.011) | 1.167b (0.011) | 1.152b (0.011) | 1.143b (0.011) | 1.137b (0.011) |
Votes | 0.345b (0.008) | — | — | — | — |
High price | 0.071b (0.023) | — | — | — | — |
Title | −0.129b (0.009) | — | — | — | — |
High rated | −0.167b (0.021) | — | — | — | — |
High hospital level | −0.190b (0.019) | — | — | — | — |
Physician fixed effects | No | Yes | Yes | Yes | Yes |
Month trends | Yes | Yes | Yes | Yes | Yes |
Month fixed effects | Yes | Yes | Yes | Yes | Yes |
.413 | .230 | .231 | .232 | .232 |
aRobust standard errors are in parentheses.
b
cNot applicable.
Estimation results of robustness check using matched samples (N=425,469).a
Variable | Prosocial behavior | ||||
Ordinary least squares | Fixed effects | Self-recognition | Recognition from others | Combined model | |
Monetary incentive | 1.622b (0.032) | 0.989b (0.029) | 0.853b (0.034) | 0.767b (0.042) | 0.709b (0.042) |
Monetary incentive × high price | —c | — | 0.319b (0.051) | — | 0.242b (0.054) |
Monetary incentive × high rated | — | — | — | 0.349b (0.050) | 0.279b (0.053) |
Control variables | — | — | — | — | — |
Letters | 1.186b (0.016) | 1.157b (0.018) | 1.132b (0.018) | 1.125b (0.018) | 1.112b (0.018) |
Votes | 0.401b (0.013) | — | — | — | — |
High price | 0.041 (0.030) | — | — | — | — |
Title | −0.018 (0.021) | — | — | — | — |
High rated | −0.192b (0.029) | — | — | — | — |
High hospital level | −0.101b (0.030) | — | — | — | — |
Physician fixed effects | No | Yes | Yes | Yes | Yes |
Month trends | Yes | Yes | Yes | Yes | Yes |
Month fixed effects | Yes | Yes | Yes | Yes | Yes |
.403 | .223 | .225 | .225 | .226 |
aRobust standard errors are in parentheses.
b
cNot applicable.
This study investigated the influence of monetary incentives on physicians’ online prosocial behaviors. Based on self-determination theory, we developed three research hypotheses and established an empirical model based on a DID design. The results of our research model support our hypotheses. Accordingly, this work provides three key findings. First, we found that the introduction of monetary incentives has a positive effect on physicians’ online prosocial behavior (as measured by free services offered). Second, this promotion effect is enhanced by physicians’ self-recognition of their personal medical competence (as measured by higher price setting). Third, the extent of patients’ recognition of physicians’ medical competence (as measured by higher rating) also can strengthen the positive effect of introductory monetary incentives on physicians’ online prosocial behaviors.
Prosocial behavior refers to any behavior that is beneficial to others and society. Prior studies mainly focus on contribution to charity [
Moreover, monetary incentives are often used to encourage contributors to improve their prosocial behaviors [
In addition, the introduction of monetary incentives may not be equally important for all physicians, and their differences should be taken into consideration. According to self-determination theory, the satisfaction of competence makes them more likely to engage in prosocial behaviors. As competence is evaluated by oneself and others, satisfaction of competence is based on self-recognition and others’ recognition of a user’s ability and performance. In particular, if physicians obtain higher self-recognition and recognition from others of their competence, they will have higher satisfaction of competence. Therefore, they will be more likely to contribute free feedback and behave prosocially. Based on the previous discussion, we found that the extent of self-recognition and patients’ recognition on physicians’ competence can strengthen the positive effect of introductory monetary incentives on physicians’ online prosocial behaviors, which gives us a better understanding of the mechanisms behind these behaviors.
There are several limitations of this study. First, our observations are of only Chinese physicians. The incentive effects may differ in other countries due to cultural differences. Future studies can investigate this issue by leveraging cross-platform datasets. Second, this preliminary study investigates the general effects of incentives on physicians’ online prosocial behaviors. More detailed settings, such as comparing online and offline environments, should be applied in future studies.
This study contributes to the literature in several ways. First, to our knowledge, this is the first study to investigate physicians’ prosocial behaviors in the telemedicine context, which adds to both streams of eHealth and prosocial behavior. Although abundant studies have examined prosocial behaviors in offline markets [
This study also offers some practical implications. First, this study indicates an effective approach to increase physicians’ online prosocial behaviors by introducing monetary incentives. This can prompt physicians to improve their allocations of service. Ultimately, patients benefit more from these extra online prosocial behaviors. Second, our findings will shed light on the facilitating roles of physician traits by testing several practice-oriented variables (price setting and rating value), which provide valuable implications to practitioners. Physicians of different types can take corresponding measures to promote themselves by providing prosocial behaviors in online platforms. Due to the imbalance issue of increasing online medical demands and limited eHealth system resources globally, physicians’ online prosocial behaviors are effective ways to compensate for medical services online and offline.
Our study investigates physicians’ online prosocial behaviors through self-determination theory embedded in an online health care platform. We extend self-determination theory in the online health care context and demonstrate the relationship between incentive mechanisms and the prosocial behaviors of physicians. The preliminary results support our theory-based model. We found that the introduction of monetary incentives has a positive effect on the volume of physicians’ online prosocial behaviors, and the extent of self-recognition and others’ recognition of physicians’ competence can strengthen this promotion effect. This means that physicians with high self-recognition and others’ recognition will make more prosocial contributions in online health care platforms.
difference in differences
This study was supported by the National Social Science Foundation of China (14CXW045). The authors greatly appreciate the work of the editors and anonymous reviewers; we are grateful for their insightful comments and suggestions. All errors remain ours.
None declared.