The Mechanism Of Online Physician-patient Multistage Interactions: A Medical Service Providing And Pricing Perspective

[Purpose]The improvement of physician-patient interaction is the key to alleviate their conflicts.Online medical service can break through the limitations of time and space,and promote physician-patient interaction.Under the situation that the traditional medical service in the hospitals has limited effects on the improvement of physician-patient relationship,the systematic research on the online physician-patient interaction is of great theoretical and practical significance.By focusing on the unique characteristics of online health communities(OHCs)—diversified services providing and flexible pricing,this study empirically explores physician-patient interaction in multiple stages.For physicians,online service providing decision,service type and pricing behavior,and service quality control behavior are included;For patients,treatment experiences posting,satisfaction rating,and compliment behaviors are included.Based on the channel theory,price theory,service quality theory,social exchange theory,and frameworks of medical resources scarcity and transaction cycle,this paper studies the influence mechanism of physician's online service providing and pricing on patient feedback,which can give theoretical support for the study of physician-patient interaction in OHCs.[Methods]This paper uses literature research,data mining,instrumental variable analysis,crosssectional data analysis,and panel data analysis to conduct three empirical analyses from the service providing and pricing perspective.Specifically,by developing a Java program to scrape physician-patient interaction data and patients' feedbacks from Haodf.com,this paper a)uses DID-PSM model to explore the effects of physician's online service providing decision on patients' feedbacks sharing,b)combines nonlinear regression model,mediating variable model,and instrumental variable model to research the influence mechanism of service type and price on patient satisfaction,and c)constructs a short-and long-term effect model to investigate the impacts of physician's service qualities at pre-,during and after-sale stages on patient's compliments.[Results]First,this study investigated the effects of physician's online service providing decision on patients' feedbacks sharing.The empirical results showed that the number of patients' feedbacks increased after the physician began to provide online services on OHCs(?=0.524,p<0.001;?=1.152,p<0.001),and the results were consistent for physicians from different departments(?=0.566,p<0.001;?=1.012,p<0.001)or with different titles(?=0.489,p<0.001;?=1.058,p<0.001).Second,this study researched the influence mechanism of service type and price on patient satisfaction.The empirical results showed that patient satisfaction was higher for physicians with more types of services(?=0.125,p<0.001;?=0.362,p<0.001;?=6.500,p<0.001;?=5.198,p<0.001).A non-linear correlation between service price and satisfaction was explored and results suggested an inverted U-shaped relationship.At the low price level,service price led to an increase in patient satisfaction,whereas the high price level(over 330 CNY)could have just the opposite effect.Importantly,the price difference of one physician's different services significantly decreased his patient satisfaction.The results revealed that the flexibility of service selection partially mediated the impact of the price difference on patient satisfaction(28.6%).Third,this study explored the impacts of physician's service qualities at pre-,during and after-sale stages on patient's compliments.The empirical results showed that service quality at each stage was an important component in driving patients to material(pre: ?=0.077,p<0.001;during: ?=0.566,p<0.001;after: ?=0.030,p<0.001)and psychological compliment(during: ?=0.303,p<0.001;after: ?=0.023,p<0.001).Considering the propensity to different compliments,high service quality at the pre-and after-sale stages motivated patients to take material compliment rather than psychological compliment(pre: ?= –0.088,p<0.001;after: ?= –0.014,p<0.001),whereas psychological compliment was more likely to be triggered for high service quality received at the during sale stage(?=0.166,p<0.001).Service price increased the influence of service quality on compliments and patients tended to give material returns over psychological returns for physicians with high service price(material: ?=0.202,p<0.01;psychological: ?=0.102,p<0.05).[Conclusions]OHCs have a practical role in promoting physician-patient interaction and should be given more attention.As physician behavior is closely related to patients' feedback behavior,the study on the influence mechanism can provide advice for physicians to increase feedbacks by adjusting and controlling their actions.This paper enriches the literature on OHCs,physician-patient interaction,price and patient behavior,and contributes to equity and social exchange theories.Based on the empirical results,this paper designs series applications,including patient feedback mechanism,bidirectional feedback mechanism,full-time online physicians team,online medical title evaluation system,multiple online services providing team,pricing recommendation system,diagnosis follow-up reminder system,and online compliments mechanism.?Innovation and deficiency?For the innovation,first,this paper focuses on the unique characteristics of online medical services: diversified services providing and flexible pricing to empirically research the influence of service providing,price and price difference on patient decision from the service providing and pricing perspective.Second,this study explores physician-patient interaction in multiple stages with the aim of improving patient feedbacks(treatment experiences posting,satisfaction rating,and compliment behaviors)and physician-patient interaction.Third,considering the risk of trust goods and online environment,this study reveals the role of price and price difference in influencing patient behavior online.Fourth,this paper constructs transaction cycle framework of online medical service,which includes pre-,during and after-service,and examines the short-and long-term effects of service quality in multiple stages on patient behavior.For the deficiency,first,based on existing studies,this paper uses response speed and reply length to measure service quality,which cannot reflect medical skill,attitude,emotion and expression.Second,endogeneity issues can be solved by designing research and choosing methods appropariately,however potential endogeneity issues for some models cannot be solved due to unobservable patient characteristics.Third,our findings may not be generalizable to other OHCs since we only collected data from one OHC in China.