Le Wang

Online healthcare consultation services (OHCS) hold immense potential to transform the healthcare industry. This study seeks to investigate the impact of doctors’ participation in OHCS on offline outpatient and inpatient costs, addressing a critical yet underexplored area in the healthcare IT literature. Utilizing an exhaustive dataset from a high-level comprehensive hospital in China over a period of 42 months, we find that doctors’ OHCS participation increases outpatient costs by 63.2% (¥268.510) and inpatient costs by 22.2% (¥2365.092). These results remain robust after addressing endogeneity concerns through instrumental variable (IV) approaches and propensity score matching (PSM). Notably, mechanism tests reveal that OHCS participation enhances doctors’ service volume expansion, cost-upgrading within services and patient mix changes, leading to induced demand and higher offline medical costs. Moreover, these effects are amplified for doctors with higher professional status. However, the COVID-19 pandemic and higher department crowding levels tend to mitigate these cost increases. This study makes several significant theoretical contributions. First, it expands the healthcare IT literature by uncovering the “dark side” of OHCS participation, showing that it raises medical costs by altering supply–demand dynamics, contrary to the cost-saving potential often associated with traditional healthcare IT. Second, it advances research on OHCS by identifying the mechanisms—service volume expansion, cost-upgrading within services and patient mix changes—through which OHCS participation influences offline costs. Third, it explores the heterogeneous effects of physician, environmental, and departmental characteristics on medical costs. Practically, our findings suggest that hospitals and policymakers should promote widespread OHCS participation to balance supply–demand dynamics, advance treatment standardization and differentiated payment models, establish a multi-dimensional physician performance evaluation system, and leverage AI technology to improve doctor–patient matching and resource scheduling—enabling the realization of online healthcare's potential without inadvertently driving up medical costs. This study highlights the nuanced implications of OHCS on offline healthcare costs, offering insights for improving its implementation in healthcare systems.

Literature has long assumed that unethical behaviors are fueled by competition. This study challenges this prevailing notion by introducing a conceptual distinction between rivalry and competition. We show that rivalry-induced deterrence triggers the formation of mutual forbearance in self-injecting favorable reviews. Mutual forbearance collapses when one party unilaterally engages in self-injecting behaviors, prompting the other party to retaliate by increasing their self-injecting activities. The presence of an additional rival leads to a 3.2% decrease in self-injecting intensity. Furthermore, self-injecting intensity increases by 0.095% for every 1% rise in that of the rivals and increases by 0.041% for a 1% rise in that of the nonrival competitors. Given the apparent role of rivalry in reducing self-injecting behaviors, platforms should strategically consider how system designs and policies can cultivate firms’ feelings of rivalry and avoid non-rival competition. We recommend platforms consider including evaluations from peer hotels as an alternative index for recommending hotels to potential consumers. Introducing peer evaluations to the current online review systems could attenuate the bias of consumer ratings and facilitate the formation of rivalry, which hinders self-injecting behaviors.

Companies in platform-based business markets have widely embraced freemium business models, in which profit is primarily determined by a minority of paying customers. However, the key challenge of these models is transitioning participants from free users to paying consumers. To encourage paid consumption, companies often rely on product differentiation such as providing consumers who pay for products or services with enhanced features. Product differentiation can be broadly classified into two categories: taste differentiation and quality differentiation. The authors demonstrate that extending the magnitude of taste differentiation is an effective differentiation strategy. Quality differentiation, however, is a double-edged sword and should be used with care. Increasing product differentiation leads to greater perceived value of the service, but undermines fairness perceptions.

Despite extensive research on user behaviours in free‐to‐play games, what motivates users to purchase in‐game items is still not well understood. We classify game affordances, gamer orientations, and in‐game items into two dimensions according to the instrumental–hedonic dichotomy. Utilising the affordance theory, we propose that the fit between game affordances and gamer orientation determines game identification, whereas the fit between game identification and gamer orientations determines in‐game purchases. We test the proposed model using a two‐wave longitudinal survey. The results suggest that instrumental gamer orientation strengthens the relationship between instrumental game affordances and game identification as well as the relationship between game identification and instrumental in‐game purchase. A hedonic gamer orientation strengthens the relationship between hedonic game affordances and game identification as well as the relationship between game identification and hedonic in‐game purchases. This paper identifies different types of game affordances and gamer orientations and examines the interactions between the two, advancing the theoretical understanding of proactive behaviours in free‐to‐play games.

Purpose: The purpose of this paper is to understand the antecedents of peer recommendations (generating positive word-of-mouth and recruiting others) in the context of mobile social games.Design/methodology/approach: Drawing on the needs–supplies fit framework and social identity theory, this paper proposes that game design characteristics (challenge, fairness, innovativeness and ease of use) influence game identification, which further predicts word-of-mouth (WOM) generation and recruitment intention. This paper further suggests fits between gamer orientation (passing time and seeking achievements) and game design lead to enhanced game identification. The model was tested using data from an empirical survey with 767 mobile social gamers.Findings: Game challenge, game fairness, game innovativeness and ease of use are positively associated with game identification, whereas game identification positively predicts WOM generation and recruitment intention. Achievement-seeking use was found to enhance the effects of game challenge and game fairness on game identification, and passing time use was found to strengthen the effects of game innovativeness and ease of use on game identification.Research limitations/implications: The findings of this study provide operable implications to facilitate peer recommendations in a mobile gaming context. The model was only tested within the context of mobile social games, however, so caution is advised when generalizing the findings to other game subgenres.Originality/value: This study distinguishes itself from other peer recommendation studies by taking recruitment, a more straightforward and salient form of peer recommendation, into account. This paper enriches theory by investigating the antecedents and consequences of game identification. This study clarifies the underlying mechanism of how game design influences peer recommendations and examines the interactions between game design and gamer orientation.

The explosion of research and development (R&D) expenditures in China brings a puzzling fact that the proportion of research in R&D is extremely small, and thus the proportion of development is large. This article distinguishes research from development in R&D and investigates the heterogeneous effects of the two components on the performance of Chinese listed firms. Using a generalized propensity score matching approach with continuous treatments, we present non-linear relationships between R&D composition and firm performance. While development-oriented firms benefit more from an increase in profit than a growth in productivity, orientation toward research contributes more to productivity gains than to profitability. Research and development activities are found to be complementary in promoting firm performance. The results suggest the existence of optimal proportions of the components of R&D for maximizing firm performance.

Purpose: The purpose of this paper is to facilitate understanding of how to mitigate the privacy concerns of users who have experienced privacy invasions. Design/methodology/approach: Drawing on the communication privacy management theory, the authors developed a model suggesting that privacy concerns form through a cognitive process involving threat-coping appraisals, institutional privacy assurances and privacy experiences. The model was tested using data from an empirical survey with 913 randomly selected social media users. Findings: Privacy concerns are jointly determined by perceived privacy risks and privacy self-efficacy. The perceived effectiveness of institutional privacy assurances in terms of established privacy policies and privacy protection technology influences the perceptions of privacy risks and privacy self-efficacy. More specifically, privacy invasion experiences are negatively associated with the perceived effectiveness of institutional privacy assurances. Research limitations/implications: Privacy concerns are conceptualized as general concerns that reflect an individual’s worry about the possible loss of private information. The specific types of private information were not differentiated. Originality/value: This paper is among the first to clarify the specific mechanisms through which privacy invasion experiences influence privacy concerns. Privacy concerns have long been viewed as resulting from individual actions. The study contributes to literature by linking privacy concerns with institutional privacy practice.

Purpose: The purpose of this paper is to explore the antecedents of self-disclosure intention on mobile social applications. This study integrates privacy calculus model and elaboration likelihood theory to reconcile the rational and heuristic views of privacy decision making. Design/methodology/approach: Using a “random dialing” sampling method, an empirical survey with 913 respondents was conducted. A series of regression models were employed to test the proposed relationships. Robust checks with sub-group analysis were conducted. Findings: Self-disclosure intention develops along a dual route including the central route and the peripheral route. When the central route predominates, social media users form their attitudes toward self-disclosure based on a rational calculus of the privacy concern and perceived rewards. When the peripheral route predominates, users perform a more heuristic evaluation of relevant informational cues (information about privacy harms, the extent of information asymmetry between users and operators) and contextual cues (flow experience, privacy disclosure of friends). Peripheral cues moderate the relationships between central cues and self-disclosure intention. Originality/value: This paper extends the Elaboration Likelihood Model by investigating the interaction between the central route and peripheral route. The results provide alternative explanations on the renowned “privacy paradox” phenomenon.