Impact of the Price of Gifts From Patients on Physicians' Service Quality in Online Consultations: Empirical Study Based on Social Exchange Theory

Background: Gift giving from patients to physicians, which is prohibited in traditional clinical settings in China, has been found to occur in online health communities. However, there is debate on the validity of online gifts since physicians gain an economic benefit. Moreover, the potential impact of these gifts, particularly with respect to the financial value of the gift, on the online consultation service quality remains unexplored. Objective: The aim of this study was to explore the impact of gift price on the quality of physicians' online consultation service. Insight into this impact is expected to help resolve existing debate on the appropriateness of the gift-giving practice in online consultations. Methods: A dataset of 141 physicians and 4249 physician-patient interactions was collected from the Good Physician Online website, which is the largest online consultation platform in China Based on social exchange theory, we investigated how gift price affects the quality of physicians' online consultation service and how this impact changes according to the physician's service price and number of all gifts received. Manual annotation was used to identify the information support paragraphs and emotional support paragraphs in the answers of physicians. The quality of the information support paragraphs, rather than the complete answer, was used to test the robustness of our model. Results: Gift price had a positive impact on the quality of physicians' online consultation service (beta=4.941, P<.01). This impact was negatively mediated by both the physician's service price (beta=-9.245, P<.001) and the total number of gifts they received (beta=-5.080, P<.001). Conclusions: Gift price has a positive impact on physicians' online behavior, although the impact varies among physicians.