Informal Payments and Doctor Engagement in an Online Health Community: An Empirical Investigation Using Generalized Synthetic Control

Online health communities are growing rapidly as more individuals seek health information online. Given the importance of doctor engagement, some online health communities have introduced informal payments to doctors to encourage knowledge sharing. This study empirically examines how informal payments in the form of monetary gifts affect doctor engagement. We leverage the launch of a gifting feature by a leading online health community as a natural experiment that exogenously provides doctors with extra monetary incentives. By adopting multiple strategies to strengthen the causal identification, we find that the introduction of the gifting feature negatively affects doctors' responses to medical consultations. Our results indicate a crowding-out effect of informal payments on doctors' intrinsic motivation to engage in such consultations. Interestingly, our consultation-level analysis suggests that monetary and nonmonetary gifts play distinct roles in motivating doctor responses, with nonmonetary gifts having a more significant carryover effect on follow-up interactions and better promoting the doctor-patient relationship. We also find that social status moderates the impact of digital gifting on online engagement. Our study has important implications for research and practice. In addition to contributing to the literature on informal payments, our results provide useful implications for online health communities that have implemented or are planning to implement digital gifting to stimulate user engagement.