What motivates Chinese physicians to provide online counseling services in Internet hospitals: online reputation or offline reputation? (Preprint)
Authors: Xu Ronghua , Zhang Tingting , Zhang Qingpeng 
Published: October 2020

BACKGROUND

Internet hospitals, or e-hospitals, as one kind of e-health platforms in China, provided novel channels through which physicians present their medical or health-care knowledge to patients and provide online counseling services. The sustainable development of Internet hospitals and e-health platforms relied on the participation of both the patients and the physicians, especially on the provision of health consultation services by the physicians.

OBJECTIVE

The objective of our study was to explore the factors motivating Chinese physicians to provide online health counseling services from the perspectives of their online reputation and offline reputation.

METHODS

We collected the data of 141,030 physicians from 6,173 offline hospitals and 350 cities on WeDoctor, an Internet hospital platform authorized by the China Health and Family Planning Committee. We selected the physicians’ online consultation volume, the total amount of counseling conversations from all channels of the platform, as the investigated dependent variable, reflecting the actual online counseling behaviors of the physicians in the platform. Based on the reputation theories and prior study, we incorporated patients’ feedback as the physicians’ online reputation (i.e. patients’ comments and their satisfaction scores), and incorporated the physicians’ offline professional status as the offline reputation (i.e. professional titles and the rankings of their offline working hospitals). We also delved the moderated effects of the city levels where the physicians lived offline and the number of patients who were watching the physicians online. Eight research hypotheses were proposed. Step-wise linear regression models were used to test our hypotheses. Durbin-Watson test and robustness tests were also conducted to ensure the fitness and reliability of our models.

RESULTS

As a result of the regression models, we found that, 1) physicians’ online reputation, including the number of comments written by the patients (beta=0.588, P<0.001), the satisfaction scores (beta=0.034, P<0.01), significantly and positively influence physicians’ online counseling behaviors; 2) Physicians’ offline reputation, including their professional titles (beta=-0.084, P<0.001) and the hospital rankings (beta=-0.163, P<0.001), significantly and negatively influence physicians’ online counseling behaviors; 3) the city levels where the physicians lived strengthen the negative effect between their offline hospital rankings and their online consulting services (beta=-0.177, P<0.001), indicating that physicians of higher offline reputation spend less time on online counseling, possibly due to the relative heavier offline workload; 4) the number of watching patients weakens the positive effect between patients’ comments and physicians’ online consulting services (beta=-0.216, P<0.001), indicating that the watching patients may switch the channels from online consultation to offline hospital visits after using the Internet hospitals.

CONCLUSIONS

This study contributed to the literature on physicians online counseling behaviors in Internet hospitals by verifying the contrasting effects of the online reputation and the offline reputation. It then contributed to the motivation theory by separating the online reputation from the offline reputation when the acting entities have constraints of limited time and effort. This study can also provide practical insights for the hospital managers to better arrange for the online counseling services and for the policy makers to consider the patients’ online feedback into the overall evaluation of the physicians’ reputation.