DELIVERY OF HEALTH SERVICES: HOW DO TECHNOLOGICAL FEATURES ON ONLINE HEALTHCARE PLATFORMS MATTER?
20 Apr 2020 Monday, 02:00 PM to 03:30 PM
COM2 Level 4
Executive Classroom, COM2-04-02
Recent years have witnessed the blossom of novel healthcare platforms, which are reshaping the delivery of health services. Despite the increasing efforts of the government in supporting these healthcare platforms, there has been little research work investigating the effectiveness of these platforms in boosting the better provision of health services. In this research, we focus on two types of online healthcare platforms that have burgeoned in recent years. One is the Health Information Exchange (HIE) platform, which allows patient-level electronic health information to be exchanged across the boundaries of health care organizations safely and securely. Another type of platform of our interest is the online medical consultation (OMC) platform, which allows patients to make online consultations with doctors remotely. Though these platforms offer the great promise of improving the delivery of health services, they do not change the principal-agent relationship between the physician and the patient. Health economic literature has demonstrated that physician agency would inevitably lead to problems such as induced demand or unsatisfying input/efforts from physicians. In our research, we intend to examine whether and how these problems arising from the issue of physician agency would affect the realized value of these online healthcare platforms.
In study 1, we investigate the role of physician agency in determining the value of HIEs. Specifically, we explore the question of whether physicians would use HIEs to reduce redundant care to reduce medical expenditures and improve hospital efficiency. Based on the theory of physician agency and literature on health information sharing, we posit that HIEs have the potential to reduce test expenditure and medication expenditure and improve hospital efficiency by curtailing redundant care; however, in the traditional fee-for-service system, physicians acting as imperfect agents of patients may not capitalize on HIEs to reduce care but rather induce care to maximize their financial interests. The hypothesis of income effects predicts that when external factors threaten physicians' incomes, they are motivated to make up for the income loss. Exploiting the phased rollout of a regional HIE in China as a natural experiment and using the cross-sectional discharge data from one of the HIE participating hospitals, we found that the availability of HIE to a patient (i.e., the availability of patient data to the patient and his healthcare providers) directly reduced test expenditure of a hospitalization episode, but it indirectly increased medication expenditure of a hospitalization episode such that increase in the percentage of patients having access to the HIE in a department led to increases in medication expenditure for patients admitted in the same department. Besides, the availability of HIE to a patient could reduce the length of stay for patients in high-demand departments, and this could help to attenuate the potential increase in the medication expenditure.
In study 2, we examine how the virtual gifts given by patients would influence doctors' contributions. We develop a model of the patient-doctor interactions based on trust-reciprocity models and prior literature on gift-giving. We employ a latent class model jointed with a dynamic probit model to capture the doctors' unobserved cooperation tendency in each consultation session and examine how it is affected by the patients' gift-giving behavior. Our model accommodates mechanisms occurring at different levels. Using data crawled from a leading Chinese OMC platform, we demonstrate that gifts positively affect doctors' cooperation tendency through the mechanism of general trust belief at the generalized level and in turn, affect doctors' efforts. Furthermore, there is no evidence supporting the mechanisms of direct trust and direct reciprocity occurring at the dyad level.
This thesis contributes to the literature on the value of online platforms in addressing problems related to the physician's provision of health care and offers crucial practical guidance on the utilization of these healthcare platforms.