Exploring the impact of review valence, disease risk, and trust on patient choice based on online physician reviews

https://doi.org/10.1016/j.tele.2019.101276Get rights and content

Highlights

  • Online physician review valence was positively related to physician selection.

  • Negative online reviews had greater influence on physician selection than positive reviews.

  • High-risk disease strengthened the influence of online review valence on physician selection.

  • Trust in OPRs was positively/negatively related to physician selection in the case of positive/negative online reviews.

Abstract

Consumers’ growing reliance on the Internet as an information source for decision making has raised the need for more research into online physician reviews (OPRs). This study conducted scenario experiment to explore how online review valence (positive vs. negative reviews), disease risk (high vs. low risk) and trust impact health consumers’ choices when they are exposed to a neighbor-recommended physician. The results suggested that online review valence was positively related to physician selection, and negative reviews had greater influence than did positive reviews. The disease risk also impacted consumers’ physician selection. A high-risk disease strengthened the influence of online review valence on physician selection. Trust in OPRs was positively related to physician selection in the case of positive online reviews, whereas it was negatively related to physician selection in the case of negative online reviews. Limitations and future directions were discussed.

Introduction

With the development of user-generated content (UGC), physician rating websites (PRWs) provide health consumers with a novel forum to post reviews of physicians and report their medical experiences (Liu et al., 2016). These PRWs also become important and influential information source in health consumers’ physician selection processes, since consumers have formed the habit of relying on online reviews to make purchase decisions in the e-commerce era (Hanauer et al., 2014). Even through physicians always doubt the authenticity and validity of online physician reviews (OPRs), large numbers of anonymous patient-generated online comments impel health providers to face the challenge of managing their online reputations (Ellimoottil et al., 2013b). In particular, many PRWs in China cooperated with hospitals and physicians to provide online booking and medical services in the last two years. Patients are generating increasingly more OPRs which are increasingly popular among health consumers. Health providers need new knowledge about how OPR impact health consumers’ decision-making processes.

Prior marketing studies confirmed that online reviews not only affect consumer decisions (Amblee and Bui, 2011) but also affect product sales (Hu et al., 2008). Researchers had conducted empirical studies in different fields, such as hotels (Serra Cantallops and Salvi, 2014), travel (Sotiriadis and van Zyl, 2013), restaurants (Yan et al., 2015), books (Chevalier and Mayzlin, 2006), etc. to investigate how the different characteristics of online reviews affect consumer purchasing decisions.

In the healthcare sector, OPRs have also attracted researchers’ attention. Some studies focused on different PRWs in the U.S., Germany, Australia, Canada, Switzerland and China, and analyzed the characteristics of OPRs, such as the likelihood of being rated, average rating scores, the number of reviews, and topic analysis of narrative reviews (Atkinson, 2014, Ellimoottil et al., 2013a, Emmert et al., 2017, Emmert et al., 2015, Emmert et al., 2014, Hao, 2015, Hao et al., 2017, Hao and Zhang, 2016, Kadry et al., 2011, Lagu et al., 2010, Lagu et al., 2019, Liu et al., 2018, Hong et al., 2019, McLennan, 2019). The relationships between physicians’ personal characteristics (e.g., age, region, gender and specialty) and the OPR information were also investigated (Emmert and Meier, 2013, Gao et al., 2012, Jack et al., 2018, Nwachukwu et al., 2016, Obele et al., 2017). In addition to the content analysis of OPRs, some researchers examined the awareness and usage of OPRs by consumers and physicians, as well as related factors (Emmert et al., 2013, Galizzi et al., 2012, Hanauer et al., 2014a, Holliday et al., 2017, Lagu et al., 2017, McLennan et al., 2017, Tanne, 2013, Terlutter et al., 2014).

Furthermore, a small number of studies also focused on how OPRs affect health consumers’ decision-making processes. Hanauer et al. (2014) reported that respondents were more likely to choose a physician who had positive online ratings. Grabner-Kräuter and Waiguny (2015) indicated that review quantity and review style had an impact on patient’s attitudes toward the rated physician. The position and proportion of negative reviews also impacted readers’ intention to select the reviewed physician (Li et al., 2015). Lu and Wu (2016) found that the disease risk moderated the relationship between physicians’ service quality and patients’ choices. Li et al. (2018) found that OPRs affected people’s willingness to choose a physician due to their influence on people’s perceptions of the physician’s interpersonal and technical skills. Nonclinical ratings provided by commercial websites were perceived as important as clinical ratings provided by government websites when choosing a primary care physician (Yaraghi et al., 2018). Carbonell et al. (2018) confirmed that the number of online reviews that a physician received influenced participants’ decisions to visit the physician. Participants tended to base their selection of a physician on patient than expert advice if patient advice was based on high number of reviews (Kranzbühler et al., 2019). Participants were also found to place more weight on technical skills than interpersonal skills in their selection of a physician based on OPRs (Li and Hubner, 2019). Deng et al. (2019) indicated both the effort and online reputation of a physician contribute to the increased number of online patients’ consultations. In general, even though the influence of OPRs is an important issue for health providers, the related research to understand health consumers behavior is still insufficient. Additionally, most of the experimental studies that were mentioned above were based in western countries. In fact, PRWs have greatly developed in China with the official promotion of the ‘Internet + healthcare’ strategy in recent years. Since the consumer behaviors in each country may differ, regional perspectives are needed. Furthermore, disease risk and trust are important factors in physician selection scenarios. Few studies have examined the effects of these two factors on health consumers’ decision-making behavior.

To fill the research gaps and gain a better understanding of how OPRs influence consumers’ choice, we conducted this scenario-based study to explore how online review valence (positive vs. negative), disease risk (high vs. low) and trust in OPRs impact the physician selection for Chinese health consumers when they are exposed to a neighbor-recommended physician. From a business perspective, our study is vital to further understand the relationship between online reviews and health providers’ performance. The rest of this paper is organized as follows. First, we present our hypotheses based on the related literature. Then, we describe the research methodology that is used in this study, which is followed by the results and discussion. We conclude the paper by pointing out its limitations and future research directions.

Section snippets

Influence of online review valence

Peer influence is the effect on individuals who are encouraged to follow their peers by changing their behaviors or attitudes (Gardner and Steinberg, 2005). With the development of e-commerce and the large amount of UGC, peer influence from online reviews is playing an increasing important role in consumers’ decision-making processes in addition to traditional offline peer recommendations. Online reviews were helpful in reducing information asymmetry (Manes and Tchetchik, 2018) and were

Experiment and questionnaire design

To test the hypotheses, we conducted a scenario experiment and each participants was required to report their trust in OPRs and physician selection intentions under six different scenarios (see Appendix A). First, we provided two physician selection scenarios according to disease risks. (e.g., the son of a good friend is diagnosed with leukemia /a cold and a neighbor has recommended physician Zhang. The participants need to help the friend to select the physician based on given OPRs). Leukemia

Sample characteristics

The demographic characteristics are described in Table 2. 68.4% of participants were 25 to 40 years old. 60.1% were female and 70.4% were married. With respect to their educational levels, 94.6% completed college or had a higher level of education. 80.3% of participants’ monthly income was between 3000 ($440) and 12,000 RMB ($1764). 76.2% lived in a provincial city or metropolis, and 85% spent more than 3 h a day on the Internet.

Results of hypotheses test

H1a, H1b and H1c were about how the online review valence impacts

Discussion

Numerous studies have investigated how different online review characteristics impact consumer behavior (Vermeulen and Seegers, 2009, Wang et al., 2017, Zhang et al., 2014), but few studies have examined online reviews in the healthcare sector, particularly in China where the government has been advocating the use of the Internet to promote healthcare services. However, these issues deserve more scholarly attention as OPRs become increasingly more popular and widely used by health consumers.

Limitations and future direction

Although our research provides useful insights, it still has some limitations. First, we mainly used the snowball sampling method and focused on well-educated people living in cities in China. There is the possibility of selection bias among respondents, even though they are indeed potential OPR information users. A large randomized sample would certainly be desirable in future studies. Second, we just examined the effect of review valence on consumers’ selections. Actually, the number of

Conclusion

With the implementation of the “Internet + healthcare” strategy in China, PRWs are becoming increasing popular among young well-educated health consumers. OPR information would inevitably affect consumers’ decision-making process. This study used a scenario experiment to examine how review valence, disease risk and trust impact health consumers’ physician selection. Our results indicated that online review valence indeed had a significant influence on consumers’ physician-selecting decisions,

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

The research was supported by National Social Science Fund of China (No. 19CTQ025) and MOE (Ministry of Education in China) Project of Humanities and Social Sciences (No.18YJC870016). We wish to express our appreciation to the research participants of this study. We also thank editors, anonymous reviewers for their thoughtful comments and constructive suggestions during the process.

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