Research On The Impacts Of Virtual Gifts From Patients And Patients’ Motives For Gift-giving In Online Healthcare

To solve the problem of shortage and uneven distribution of high-quality medical resources,China government has actively promoted the construction of the "Internet Plus Healthcare" in recent years.Online healthcare consultation platforms provide patients with health consultation and remote diagnosis services in order to improve the fairness and accessibility of healthcare.To motivate doctors to provide online healthcare services,many platforms allow patients to give doctors small virtual gifts as an expression of gratitude for doctors’ high-quality service.The implicit assumption is that expensive gifts influence the quality of service provided by doctors and generate conflicts of interest but small gifts do not.However,there is little empirical evidence to support this assumption.Patient gift-giving may affect not only the quality of service provided by doctors to giftgivers,but also to non-givers unintendedly.In addition,although gifts can be a genuine expression of gratitude,patients may have other motives for gift-giving(e.g.,as a strategy to elicit better service).Therefore,allowing patients to give small virtual gifts to doctors,a seemingly innocuous act may undermine the fairness of healthcare and arise ethical issues.This defeats the intention of developing online healthcare.Based on detailed online healthcare consultation data from a leading online healthcare platform in China,this paper investigates how small gifts from patients impact the quality of service provided to gift-givers and to non-givers.This paper examines three aspects of online healthcare service quality: patient wait time,the degree of informational support in doctors’ responses,and the degree of socio-emotional support in doctors’ responses.This paper further investigates patients’ motives for gift-giving.First,examining the impacts of patient gift-giving on the quality of services provided by doctors to gift-givers(i.e.,direct effects).To make credible causal inference,this paper uses two identification strategies.The first empirical strategy employs ordinary least squares(OLS)estimation.To address the potential endogeneity issue,this paper identifies alternative explanations that threaten causal inference and runs extra analyses to rule out these alternative explanations.The second empirical strategy uses a fuzzy regression discontinuity design(RDD),which exploits an event that exogenously increased the likelihood of patient gift-giving,and estimates the effects of gifts in a narrow window around the event.The results show that despite the gifts’ negligible monetary value,doctors who receive gifts do reciprocate to the gift-givers by providing them with more timely responses and greater emotional support.Second,based on the established direct effect of patient gift-giving,this paper further examines the impact of patient gift-giving on the quality of services provided by doctors to non-givers(i.e.,spillover effect).The results show that,after receiving small gifts,doctors will be slower in responding to non-givers and offer them less emotional support.In addition,this study shows that the spillover effect of gifts on patient wait time is significantly larger than its direct effect.Therefore,the gift-giving feature distorts the allocation of resources away from a socially efficient allocation and reduces patients’ welfare.This paper further finds that the spillover effect of gifts on patient wait time is larger for doctors with greater professional experience and for doctors who live in the first-tier cities.Finally,based on the findings on the direct effect and spillover effect of patient giftgiving,this paper further examines patients’ motives for gift-giving including expressing gratitude,eliciting better service,and the impact of other patients’ gift-giving.This paper shows that patient gift-giving is more likely to be a strategy to elicit better treatment than a genuine expression of gratitude.The analyses also show that after seeing other patients give gifts to a doctor,a patient will be more likely to give gifts as well(i.e.,peer effects).By observing gift-giving among peers,patients can discover that doctors differentiate between gift-givers and non-givers,and therefore give gifts as well.Based on the practice of online healthcare in China,this paper systematically analyzes the impact of patient gift-giving and motives for patient gift-giving through three closely related studies.This paper establishes the causal relationship between patient gift-giving and the quality of service provided by doctors,identifies motives for patient gift-giving,and reveals the mechanisms driving peer effects.The findings of this paper improve the understanding of patient gift-giving behavior and provide credible empirical evidence for the long-term debate on whether patient gift-giving is ethically acceptable.This paper has important practical implications for the design of online healthcare platforms,provides useful insights for healthcare policymaking,and has implications for policies related to patient gift-giving in offline healthcare contexts.