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Prior studies on the impact of incentives on physicians’ online participation mainly focused on different incentives while ignoring the difficulty of setting monetary incentives efficiently. Based on goal-setting theory, the current research examines the relationship between incentives with goals of varying difficulty and professional health knowledge sharing (PHKS) in online health knowledge-sharing platforms (OHKSPs).

Four field experiments with different monetary incentives were conducted by one of China’s largest OHKSPs, with whom the researchers cooperated in data collection. Monthly panel data on 10,584 physicians were collected from September 2018 to December 2019. There were 9,376 physicians in the treatment group and 1,208 in the control group. The authors used a difference-in-difference (DID) model to explore the research question based on the same control group and the Chow test with seemingly unrelated estimation (sureg) to compare regression coefficients between four groups. Several robustness checks were performed to validate the main results, including a relative time model, multiple falsification tests and a DID estimation using the propensity score matching method.

The results show that the monetary incentive significantly positively affected the volume of physicians’ PHKS directly with negative spillover to the duration of physicians’ PHKS. Moreover, the positive effect of incentives with higher difficulty on the volume of physicians’ PHKS was significantly smaller than that of incentives with low difficulty. Finally, professional title had a positive moderating effect on the volume of goal difficulty setting and did not significantly moderate the effect on the duration of physicians’ PHKS.

Some limitations of this study are: firstly, because the field experiments were enterprise benefit oriented, the treatment and control groups were not balanced. Secondly, the experiments for different incentive measures were relatively similar, making it challenging to validate a causal effect. Finally, more consideration should be given to the strategy for setting hierarchical incentives in future research.

The research indicates that monetary incentives have a bilateral effect on PHKS, i.e. a positive direct effect on the volume of physicians’ contributions and a negative spillover effect on the duration of physicians’ PHKS. The professional titles of physicians also moderate such bilateral switches of PHKS. Furthermore, when a physician’s energy is limited, the goal difficulty setting of the incentive mechanism tends to be low. The more difficult the incentives are, the more inefficient the effects on physicians’ PHKS will be.

Knowledge sharing in online health communities (OHCs) disrupts consumers' health information-seeking behavior patterns such as seeking health information and consulting. Based on social exchange theory, this study explores how the two dimensions of experts' free knowledge sharing (general and specific) affect customer transactional and nontransactional engagement behavior and how the quality of experts' free knowledge sharing moderates the above relationships.

We adopted negative binomial regression models using homepage data of 2,982 experts crawled from Haodf.com using Python.

The results show that experts' free general knowledge sharing and free specific knowledge sharing positively facilitate both transactional and nontransactional engagement of consumers. The results also demonstrate that experts' efforts in knowledge-sharing quality weaken the positive effect of their knowledge-sharing quantity on customer engagement.

This study provides new insights into the importance of experts' free knowledge sharing in OHCs. This study also revealed a “trade-off” between experts' knowledge-sharing quality and quantity. These findings could help OHCs managers optimize knowledge-sharing recommendation mechanisms to encourage experts to share more health knowledge voluntarily and improve the efficiency of healthcare information dissemination to promote customer engagement.

In 2011, Brazil introduced a national pay-for-performance (P4P) scheme called the National Program for Improving Primary Health Care Access and Quality (PMAQ), rolled out over three cycles and reaching more than 5,000 municipalities and 40,000 family health teams (FHTs). There is little evidence on how the PMAQ was implemented locally and whether this variation in implementation affects performance, particularly, in terms of work process indicators. This study compared different cases of municipal-level PMAQ implementation (bonuses paid or not to FHTs) over the last two program cycles to analyze the quality of the work processes, actions and services of FHTs.

This was a cross-sectional analytical study using secondary data from an external evaluation of the Brazilian PMAQ. In total, 27,500 FHTs participated in the evaluation. They were divided into four clusters based on whether or not municipalities paid bonuses to workers during cycles 2 and 3 of the program (2013–2019). Variables regarding work processes, actions and services were classified as “Quality Assurance – QA” or “Continued Quality Improvement – CQI”, and an individual score was assigned based on the average score of each variable.

The four clusters displayed an increase in overall QA and CQI scores between the two program cycles; though this increase was small between the set of primary health care teams that received bonuses and those that did not.

This paper contributes to bridging the gap in the scientific literature for evaluative studies on the relationship between direct payment for performance to health professionals and better quality actions and services in low and middle-income countries.

The use of pay for performance (P4P) as an instrument to incentivise quality improvements in health care is at a crossroads in high-income countries but has remained a commonly used tool in low- and middle-income countries. The authors aimed to take stock of the evidence on effectiveness and design from across income settings to reveal insights for the future design of performance payment across income contexts.

The authors identified Cochrane literature reviews of the use of P4P in health care in any income setting, tracked the development in the quantity and quality of evidence over time, and compared the incentive design features used across high-income countries compared to low- and middle-income countries.

The quantity and quality of the evidence base have grown over time but can still be improved. Scheme design varies across income settings, and although some design choices may reflect differences in context, the authors find that incentive designers in both income settings can learn from practices used in the other setting.

The research and literature on P4P in high-, low- and middle-income countries largely operate in silos. By taking stock of the evidence on P4P from across income settings, the authors are able to draw out key insights between these settings, which remain underexplored in the literature.

This research intends to develop a model for predicting employees at a high-risk attrition and identify the most important factors affecting them.

In this study, using the triangulation technique of a mixed research method, the employee attrition problem is investigated by identifying its affecting factors. For that matter, data related to the human resources department of a pharmaceutical company in Iran are used. And to achieve the intended goal, advanced data mining algorithms and interviews with human resource managers are applied.

A model for predicting employees at a high-risk attrition is presented based on the gradient boosting machine algorithm with 89% accuracy. The use of the mixed research approach shows that qualitative and quantitative methods can be more effective in identifying the factors affecting employee churn or loss of staff. The results also contain a new situation arising out of the COVID-19 pandemic and remote working scenarios having impact on employee attrition. Finally, human resource policies are presented based on variables related to each of the identified factors.

The novel contributions of this study include real data related to a leading pharmaceutical company as well as a combination of two quantitative and qualitative methods. The hybrid approach can identify the reasons for attrition and, consequently, retention policies to benefit from the advantage of both approaches. Data mining can be useful to identify the factors, which are usually not mentioned in termination interviews, such as direct managers. On the other hand, the results obtained from termination interviews can also include features that the authors cannot identify through data mining, which are specifically related to the characteristics of the pharmaceutical industry such as building a more professional career path. From a practical perspective, since this company specializes in pharmaceutical marketing in a new way and is primarily comprised graduates, it is important to note that the churn of specialized people disperses organizational and technological know-how. On the other hand, the pharmacist community in Iran is small, and their attrition might adversely affect not only the reputation of an organization but the employer's brand as well. So, this research would help other similar firms in retaining their valuable human capital.

New Public Management-informed pay-for-performance policies are common in public sectors internationally but can be controversial with delivery agents. More attention is needed on contingent forms of bottom-up implementation of challenging policies, in emerging market economies, for professionals who face tensions between policies and their codes of practice. Street-level bureaucrats (SLBs) mediate policy implementation through discretionary practices; health professionals have enhanced space for discretion based on autonomy derived from professional status. The authors explore policy implementation, adaptation and resistance by physicians, focusing on payments for health workers in Turkey.

The researchers conducted semi-structured qualitative interviews with 12 physicians in Turkish hospitals and thematic analysis of interview transcripts, using a blended (deductive and inductive) approach.

The policy fostered discretionary behaviours such as cherry-picking (high volume, low risk procedures) and pro-social rule-breaking (e.g. “upcoding”), highlighting clinical autonomy to navigate within policy restrictions. Respondents described damage to relationships with patients and colleagues, and dissonance between professional practice and perverse policy incentives, sometimes leading to disengagement from clinical work. Policymakers were perceived to be detached from the realities experienced by SLBs. Tensions between the policy and professional values risked alienating physicians.

This study utilises participant self-reported perceptions of discretionary behaviours. Further work may adopt alternative methods to explore the relationship between self-reporting and observed practice.

The authors contribute to research on differentiated, contingent roles of groups with high scope for discretion in bottom-up implementation, pointing to the potential for policy-professional role conflicts between top-down P4P policies, and the values and codes of practice of professional SLBs.

Social media facilitates the communication and the relationship between healthcare professionals and patients. However, limited research has examined the role of social media in a physicians' online return. This study, therefore, investigates physicians' online economic and social capital return in relation to physicians' use of social media and consumer engagement.

Using ordinary least squares (OLS) regression with fixed effects (FE) and panel data collected from Sina Weibo and Sina Health, this study analyzes the impact of physicians' social media use and consumer engagement on physicians' online return and the moderation effect of professional seniority.

The results reveal that physicians' use of social media and consumer sharing behavior positively affect physicians' online economic return. In contrast, consumer engagement positively impacts physicians' online social capital return. While professional seniority enhances the effect of physicians' social media use on online economic return, professional seniority only enhances the relationship between consumers' sharing behavior to the posts and physicians' online social capital return when professional seniority comes to consumer engagement.

This study reveals the different roles of social media use and consumer engagement in physicians' online return. The results also extend and examine the social media affordances theory in online healthcare communities and social media platforms.

Drawing on the pay-for-performance (P4P) and job satisfaction literatures through an analysis of qualitative studies published on the topic, the purpose of this study is to investigate the effect of a P4P-based system on job satisfaction and dissatisfaction among health care workers.

A meta-synthesis of the qualitative literature was conducted to investigate health care workers' opinions, perceptions and behaviors and fully understand what processes generate job satisfaction or dissatisfaction under P4P systems.

The findings suggest that P4P systems impact the job (dis-)satisfaction of health care workers based on the institutional, organizational, geographic and cultural context of reference. Specifically, job satisfaction – and thus motivation, occupational well-being and work engagement – can occur when the context is supportive, whereas job dissatisfaction – and thus work stress and pressure, burnout and work-life balance issues and distraction – is generated in the case of unsupportive contexts. Moreover, the findings suggest a virtuous/vicious circle whereby job satisfaction leads to positive performance and further fuels job satisfaction, while conversely job dissatisfaction generates worse performance, and this further worsens worker satisfaction.

There is a lack of studies comparing and analyzing current evidence on the job (dis-)satisfaction of health care workers operating in different contexts based on the reward system. This is the first research to analyze a significant number of studies with reference to the relation between P4P and job (dis-)satisfaction, which are topics in need of further study and investigation in health care settings around the world.

This study aims to demonstrate the evaluation of an incentive scheme to encourage pregnant people to set a quit-smoking date.

The paper outlines a collaborative approach, working with pregnant people, clinicians, tobacco dependency practitioners and academics to gain insights into their perspectives and experiences. Quantitative and qualitative data were analysed.

The incentive scheme and appropriate support from clinicians have been shown to encourage pregnant people to set a quit date. The tobacco dependency practitioners helped remove barriers, such as the perception of the stigmatisation of smoking when pregnant. The practitioners also helped pregnant people make informed decisions to support successful behaviour change. The impact of the scheme resulted in improved infant health indicators. The scheme’s evaluation also supported establishing stakeholder knowledge exchange and learning processes.

This is a single-site study among a relatively small group of people designed to achieve a specific evaluation objective. Caution in generalising to wider settings should be exercised.

This study highlights the efficacy of an incentive scheme, complemented with support from clinicians, and the significance of knowledge exchange and collaboration between stakeholders in health care with significance in similar settings.

The paper details the incentive scheme input, actions, output, outcomes and impact involving a wider range of stakeholders, including the emotional consequences for participants, clinicians and academics.

Online health question-and-answer (Q&A) forums have developed a new business model whereby listeners (peer patients) can pay to read health information derived from consultations between askers (focal patients) and answerers (physicians). However, research exploring the mechanism behind peer patients' purchase decisions and the specific nature of the information driving these decisions has remained limited. This study aims to develop a theoretical model for understanding how peer patients make such decisions based on limited information, i.e. the first question displayed in each focal patient-physician interaction record, considering argument quality (interrogative form and information details) and source credibility (patient experience of focal patients), including the contingent role of urgency.

The model was tested by text mining 1,960 consultation records from a popular Chinese online health Q&A forum on the Yilu App. These records involved interactions between focal patients and physicians and were purchased by 447,718 peer patients seeking health-related information until this research.

Patient experience embedded in focal patients' questions plays a significant role in inducing peer patients to purchase previous consultation records featuring exchanges between focal patients and physicians; in particular, increasingly detailed information is associated with a reduced probability of making a purchase. When focal patients demonstrate a high level of urgency, the effect of information details is weakened, while the interrogative form is strengthened.

The originality of this study lies in its exploration of the monetization mechanism forming the trilateral relationship between askers (focal patients), answerers (physicians) and listeners (peer patients) in the business model “paying to view others' answers” in the online health Q&A forum and the moderating role of urgency in explaining the mechanism of how first questions influence peer patients' purchasing behavior.