Social contagion of online physician choice: the infection and immunity mechanism
| Date | 22 September 2023 |
| Pages | 133-152 |
| DOI | https://doi.org/10.1108/AJIM-02-2023-0067 |
| Published date | 22 September 2023 |
| Author | Jia Li,Shengkang Ma,David C. Yen,Ling Ma |
Social contagion of online
physician choice: the infection and
immunity mechanism
Jia Li and Shengkang Ma
East China University of Science and Technology, Shanghai, China
David C. Yen
Texas Southern University, Houston, Texas, USA, and
Ling Ma
East China University of Science and Technology, Shanghai, China
Abstract
Purpose –In the digital age, the spread of online behavior and real-world information leads to social
contagion. This study aims to investigate the contagion phenomenon of online physician choice and then
discuss its potential influence on the sub-specialization process in the healthcare service industry. In specific,
this study aims to propose the basic mechanism of infection and immunity as follows –exposure to antigen
may lead to an immune response, and the success of the immune response may depend on the provision of
appropriate immune signaling.
Design/methodology/approach –Data collected from haodf.com including 4 disease types and 247
physicians from 2008 to 2015 were used to test the proposed hypotheses. Panel vector autoregression method
was utilized to analyze the panel data.
Findings –The obtained result shows that social contagion of physician choice over disease type is salienton
e-consultation platforms, indicating that physicians associated with/on haodf.com are concentrating on an
even narrowertype ofdisease. Disclosingmore simple signals (physician history orders) results in more disease
concentration for that physician in the future. In contrast, disclosing more detailed signals (physician-
contributed knowledge or physician reviews) leads to less disease concentration.
Originality/value –This finding implies that physician-contributed knowledge and physician reviews may
act as immune signal which will tend to trigger a success immune response. This study not only suggests
managers should be careful about the double-edged sword effect of online physician choice contagion but also
provides the useful approaches to promote or restrain such a contagion in a flexible way.
Keywords E-health, Online consultation, Social contagion, Infection and immunity,
Panel vector autoregression
Paper type Research paper
1. Introduction
Going online and transmitting information service via the Internet is a major trend of digital
transformation in healthcare (Wang et al., 2020). Such a transformation manifests more
information (e.g. sales history, physician reviews, knowledge contributed, etc.) to be disclosed
and shared online, which may dramatically change the decision-making of/for physician
choice. The most common reaction when patients are exposed to other’s choice is called
“conformity choice.”In the conformity choice mode, the decision was made mainly by
following the choice of others. For example, patients can more easily identify the most high-
profile doctors online, creating the “Superstar”or “winner-take-all”markets where some very
good doctors may be able to dominate the whole market (Li et al., 2016). Going online may also
Social contagion
of online
physician
choice
133
This research was supported by the National Natural Science Foundation of China (grant numbers:
72271093 and 71971082) and Humanity and Social Science Youth foundation of Ministry of Education of
China (grant number: 18YJC630068).
The current issue and full text archive of this journal is available on Emerald Insight at:
https://www.emerald.com/insight/2050-3806.htm
Received 27 February 2023
Revised 17 May 2023
Accepted 25 July 2023
Aslib Journal of Information
Management
Vol. 77 No. 1, 2025
pp. 133-152
© Emerald Publishing Limited
2050-3806
DOI 10.1108/AJIM-02-2023-0067
accelerate the ongoing trend toward the sub-specialization and sub-sub-specialization in the
healthcare service industry and this is simply because the online market favors physicians
whose expertise may be different from that of the majority, and also the fact that competition
in the online market may turn out to be much stronger than in the offline market (Li et al.,
2020). All these findings obtained from the prior studies about the consequences of
information disclosure in the online consultation markets can be explained and justified by
the mechanism of social contagion (Stephenson and Fielding, 1971). In other words, a user will
copy the choice made by the previous patients whom they have been exposed to. By doing so,
the online market will be more concentrated on the superstar physicians or favor the
physicians who are limited by specialized skills.
The rule of social contagion can be also applied to the physician choice at the sub-
specialization level which is the division of labor within a clinical specialty (Li et al., 2020).
Sub-specialization usually occurs in a particular area of expertise within a specialty. For
example, one endocrinology physician may sub-specialize in diabetes, while another one may
sub-specializes in hyperthyroidism. Moreover, sub-sub-specialization may occur in a
particular sub-specialization. For example, one diabetes physician may sub-sub-specialize
in Type 1 diabetes, while another one may sub-sub-specialize in Type 2 diabetes. Due to the
effect of social contagion, future users may have more likelihood to copy the choices of
previous patients over disease types. For this reason, online physicians are concentrating
more on narrower type of diseases (e.g. concentrating only on Type 1 diabetes), thus
accelerating the ongoing trend of sub-specialization. From the discussion above, the first
research questions in this study can be introduced as follows:
RQ1. Is there a social contagion in the online health consultation market when users
choose physicians at the sub-specialization level? Are online physicians working on
more and more concentrated types of diseases?
Although sub-specialization is considered to be a “historically inevitable process”that has
been forced upon the medical profession (D€
ohler, 1993), its effect may prove to be on two
different sides. On one hand, sub-specializationmaybeabletoimprovetheoutcomeof
healthcare such as decreased surgical complication rates and this is simply because
physicians are more and more doing what they are good at (Tejwani et al., 2016;Das and
Guillaume, 2018). On the other hand, the continued branching of medical specialties into an
even narrower circumscribed territories could create a negative effect on/to the patient
welfare (Oren et al., 2020). From the above discussion, it is critical to understand the
contagion mechanism of the physician choice and try to find ways to promote or restrain
the social contagion for/under different contexts. For example, we may want/prefer more
social contagion of physician choice for the very complicated diseases to promote sub-
specialization, but we may opt for less social contagion of physician choice for chronic
disease to restrict the sub-specialization (Li et al., 2020). The restrain of social contagion is
actually possible by activating the patient’s independent thinking. In the “independent
choice”mode, the decision is made by analyzing the physician’s characteristics (reflected
in the physician reviews or contributed knowledge) and the patient’s own needs.
Specifically, we are interested in activating or turning off such an immune mechanism by
proper manipulation of the patient’suseofa“conformity choice”or an “independent
choice”. In addition, the key difference between a “conformity choice”and an “independent
choice”may result from providing “simple”or “detailed”signals. The simple signals only
provide the choice of other patients, while detail signals provide other detailed information
about the physician (e.g. through physician reviews and/or physician-contributed
knowledge). As a result, the second research question in this study can be introduced
as follows:
AJIM
77,1
134
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