For free or paid? A comparison of doctors' intention to offer consulting services in eHealth

Considering both online and offline service scenarios, this study aims to explore the factors affecting doctors' intention to offer consulting services in eHealth and compare the factors between the free- and paid-service doctors. The theory of reasoned action and social exchange theory are integrated to develop the research model that conceptualizes the role of extrinsic motivations, intrinsic motivations, costs, and attitudes in doctors' behavioral intentions.

Partial least square structural equation modeling (PLS-SEM) was leveraged to analyze 326 valid sample data. To provide robust results, three non-parametric multigroup analysis (MGA) methods, including the PLS-MGA, confidence set, and permutation test approaches, were applied to detect the potential heterogeneity between the free- and paid-service doctors.

The results with overall samples reveal that anticipated rewards, anticipated associations, anticipated contribution, and perceived fee are all positively related to attitude, which in turn positively influences behavioral intention, and that perceived fee positively moderates the relationship between attitude and behavioral intention. Attitude's full mediation is also confirmed. However, results vary between the two groups of doctors. The three MGA approaches return relatively convergent results, indicating that the effects of anticipated associations and perceived fee on attitude are significantly larger for the paid-service doctors, while that of anticipated rewards is found to be significantly larger for the free-service doctors.

eHealth, as a potential contactless alternative to face-to-face diagnoses, has recently attracted widespread attention, especially during the continued spread of COVID-19. Most existing studies have neglected the underlying heterogeneity between free- and paid-service doctors regarding their motivations to engage in online healthcare activities. This study advances the understanding of doctors' participation in eHealth by emphasizing their motivations derived from both online and offline service scenarios and comparing the differences between free- and paid-service doctors. Besides, horizontally comparing the results by applying diverse MGA approaches enriches empirical evidence for the selection of MGA approaches in PLS-SEM.