Background: Online healthcare communities are changing the ways of physician-patient communication and how patients choose outpatient care physicians. Although a majority of empirical work has examined the role of online reviews in consumer decisions, less research has been done in health care, and endogeneity of online reviews has not been fully considered. Moreover, the important factor of physician online services has been neglected in patient decisions. Objective: In this paper, we addressed the endogeneity of online reviews and examined the impact of online reviews and services on outpatient visits based on theories of reviews and channel effects. Methods: We used a difference-in-difference approach to account for physician- and website-specific effects by collecting information from 474 physician homepages on two online health care communities. Results: We found that the number of reviews was more effective in influencing patient decisions compared with the overall review rating. An improvement in reviews leads to a relative increase in physician outpatient visits on that website. There are channel effects in health care: online services complement offline services (outpatient care appointments). Results further indicate that online services moderate the relationship between online reviews and physician outpatient visits. Conclusions: This study investigated the effect of reviews and channel effects in health care by conducting a difference-in-difference analysis on two online health care communities. Our findings provide basic research on online health care communities.

China introduced the county medical community (CMC) reform, aimed to provide high-quality medical resources to rural citizens, in 2017. This study examines the impact of the reform on the medical service efficiency of county-level public general hospitals in Shanxi Province, China. In total, 92 county-level public general hospitals from Shanxi Province were taken as the research objective, and the super-efficiency SBM-DEA model was applied to measure medical service efficiency. Further, a two-way fixed-effect model was used to evaluate the impact of CMC reform on the medical service efficiency of county-level public general hospitals by using health statistics data from 2014 to 2018. The study reveals that the CMC reform improved the medical service efficiency of county-level public general hospitals by 15.6%. Moreover, the CMC reform had regional heterogeneity in its impact on the medical service efficiency of county-level public general hospitals. The CMC reform improved the medical service efficiency of hospitals in the southern region more than in the northern region of the province. The medical service efficiency of hospitals in the central region was also improved by CMC reform, but the causal relationship was not found significant. Further, hospital-level factors (e.g., fixed assets, hospital stay, and regional health center) and environmental factors (e.g., GDP, population, urbanization rate, and government subsidies) affected the medical service efficiency of county-level public hospitals during the process of promoting the CMC reform.

Purpose: Based on the diagnosis-related groups payment, China developed an innovative episode-based payment scheme, called “payment method by disease types with point counting”, to control health expenditures inflation. This study aimed to investigate the impacts of this new payment method on volume, expenditures, and efficiency in Chinese public hospitals. Methods: The study sample consisted of 7 tertiary hospitals and 14 secondary hospitals in Jinhua (intervention group) and 4 tertiary hospitals and 14 secondary hospitals in Taizhou (control group). Monthly data points were collected for each sampled hospital from June 2016 to June 2019 using a self-administered questionnaire with impact evaluation indicators. Controlled interrupted time-series analysis was employed to estimate the effect of the new payment method. Results: The significant slowing trends in inpatient expenditures per visit (tertiary hospitals: β₇=− 123.16, p=0.042; secondary hospitals: β₇=− 89.24, p=0.021) and out-of-pocket payments (tertiary hospitals: β₇=− 4.18, p=0.027; secondary hospitals: β₇=− 4.87, p=0.019) were observed after policy intervention. However, outpatient expenditures per visit in tertiary (β₇=1.67, p=0.018) and secondary hospitals (β₇=1.24, p=0.003) rose faster with the new payment method. Additionally, payment reform also caused an increase in the number of inpatient visits (β₇=100.01, p=0.038) and reduced the length of stay (β₇=− 0.10, p=0.036) in tertiary hospitals. Conclusion: The introduction of payment method by disease types with point counting causes the cost containment for inpatient care, whereas the increase in outpatient expenditures. The findings suggest this new payment scheme has the potential for rollout in other areas, but the cost-shifting from the inpatient to outpatient setting should be prevented.

Patients are turning to OHCs to deal with the stresses and complications of infertility. As a stigmatized disease, infertile patients may value informational support and emotional support differently, which is ignored in existing studies. Based on social support theory, this study aims to reveal the role of informational support and emotional support of doctors in infertile patient decision-making. We select Haodf.com as our data source and we collected information for all new patients of 2,989 doctors. we use Jieba word segmentation tool and TF-IDF algorithm to segment word and find keywords. Then random forest algorithm is used to classify 750 training texts and 250 test texts. We measure all the treatment experience of these new patients between September and December 2022 and then take the average value (TreatExpi). The sentiment analysis application program interface from Baidu AI-NLP is used to measure emotion state of patients and then the average value is included (EmoStai). In order to eliminate the influence of other factors, control variables including the number of patients online (#Patienti), the recommendation (Recommendationi), hospital level (Hleveli), doctor medical title (Mtitlei) and service price (Serpi). First, the effects of social support expressed from doctor and social support disclosed from peers show heterogeneity on patient decision-making. Second, the influences of informational support and emotional support also show difference. Third, the above relationships change with the characteristics of patients. Detecting different types and different sources of social support activities via text mining contributes to between understanding patient decision behavior in OHCs. This study contributes social support theory and OHC studies, and helps the management and design OHCs.

Background: Web-based medical services have become an effective supplement to traditional services in hospitals and an essential part of medical services. Studies have shown that web-based medical services are useful for shortening the delayed admission time and for enhancing the treatment effect from the service continuity perspective. However, the specific measures that patients and physicians should take to improve service continuity remain unknown. Objective: Based on the information richness theory and continuity of care, this study investigates the dynamic effects of information continuity and interpersonal continuity on physician services online. Methods: Data of 7200 patients with 360 physicians covering complete interaction records were collected from a professional web-based platform in China. Content analysis was performed to recognize matching patients and physicians, and least square regression analysis was performed to obtain all empirical results. Results: Empirical results showed that in the short term, information continuity (including offline experience, medical records, and detailed information) influences physicians’ web-based services, and their influences show heterogeneity. Moreover, if a patient’s online physician is the same physician who he/she has visited offline, we find that interpersonal continuity is important for service. In the long term, information continuity and interpersonal continuity positively improve service continuity by facilitating repeat purchases. Conclusions: Overall, our findings not only shed new light on patient behavior online and cross-channel behavior but also provide practical insights into improving the continuity of care in online health communities.

BACKGROUND Online healthcare communities are changing the ways of physician-patient communication and how patients choose outpatient care physicians. Although a majority of empirical work has examined the role of online reviews in consumer decisions, less research has been done in health care, and endogeneity of online reviews has not been fully considered. Moreover, the important factor of physician online services has been neglected in patient decisions. OBJECTIVE In this paper, we addressed the endogeneity of online reviews and examined the impact of online reviews and services on outpatient visits based on theories of reviews and channel effects. METHODS We used a difference-in-difference approach to account for physician- and website-specific effects by collecting information from 474 physician homepages on two online health care communities. RESULTS We found that the number of reviews was more effective in influencing patient decisions compared with the overall review rating. An improvement in reviews leads to a relative increase in physician outpatient visits on that website. There are channel effects in health care: online services complement offline services (outpatient care appointments). Results further indicate that online services moderate the relationship between online reviews and physician outpatient visits. CONCLUSIONS This study investigated the effect of reviews and channel effects in health care by conducting a difference-in-difference analysis on two online health care communities. Our findings provide basic research on online health care communities.