Researchers from Stanford University and University of Washington published a new Journal of Marketing article that examines the impact of user-generated online ratings on healthcare choices.
The study, forthcoming in the Journal of Marketing, is titled “User-Generated Physician Ratings and Their Effects on Patients’ Physician Choices: Evidence from Yelp” and is authored by Yiwei Chen and Stephanie Lee.
With the spread of technology and increased availability of information, patients increasingly rely on user-generated online ratings when choosing physicians and making other healthcare decisions. A recent survey shows that almost three-quarters of patients rely on online reviews as the first step to finding a new doctor. However, consumers typically lack the specialized knowledge required to evaluate the quality of the service and it is unclear whether online ratings signal physician quality information and whether they affect patients’ physician choices.
This new study finds that online physician rating platforms can help disseminate important quality information to patients and direct them to higher-quality physicians. Our research addresses these two questions:
- Are online ratings correlated with physician quality?
- Do online ratings affect patients’ physician choices – and if so – what are the underlying mechanisms through which ratings affect patients’ physician choices?
Despite the popularity of consumer-generated online physician ratings, their effectiveness and reliability are unclear. For example, the American Medical Association has raised concerns that user-generated physician ratings may lack useful information and that the ratings may not reflect actual patient treatment outcomes. On the other hand, online ratings can be a valuable resource: patients may be able to infer physicians’ clinical quality by observing their own health conditions or by directly assessing physicians’ empathy, attentiveness, and communication skills.
To examine the impact of user-generated online ratings on healthcare choices, the researchers combine physician rating data from Yelp.com with data from Medicare, which cover a large elderly patient group. For those consumers who base their physician choice decisions on online ratings, the findings that physicians with higher ratings have higher clinical quality indicate that patients will be matched with higher-quality physicians. The study finds that physicians with higher ratings have better educational and professional credentials measured by board certification status, ranks of schools, and accreditations. Furthermore, physicians with higher ratings show higher adherence to clinical guidelines and patients of physicians with higher ratings display better clinical outcomes. Chen says that “Our results indicate that online reviews are highly correlated with important measures of clinical quality and provide important quality signals to patients.” The researchers also examine the effects of ratings on patient flow, measured by physician’s revenue and patient volume, and find that an increase in a physician’s average rating has positive effects on patient flow and increases the physician’s annual patient revenue and volume.
The researchers use a machine learning algorithm to determine what information is included in online physician reviews. They find that reviews contain signals about physicians’ service-related quality (e.g., a physician’s bedside manner, waiting time, and office amenities) and clinical and treatment-related quality (e.g., treatment, diagnosis, prescription, and outcomes). “When choosing a physician, we find that patients respond most to information on physicians’ interpersonal and clinical skills,” says Lee.
Further, patients’ responses to online ratings are greater for physicians with more reviews. The finding is consistent with signaling theory, which indicates that ratings would signal more information about a physician’s quality when there are a greater number of reviews. The effects of ratings on patient flow are larger for physicians with more younger patients who have greater access to online rating information. Also, the positive effect of positive online ratings on patient flow is greater for solo practitioners who may lack institutional backing. For self-employed physicians who are not associated with large hospitals and brand names, good online ratings can provide extra information, help signal quality, and reduce patient uncertainty.
These findings have important implications for policymakers, healthcare managers, physicians, patients, and online physician rating platforms. Online ratings are robustly and positively associated with conventional measurements of physicians’ credentials, physicians’ adherence to clinical guidelines, and patients’ clinical outcomes. The finding that user-generated physician ratings are positively associated with important measures of physician quality highlights that online physician reviews can be a reliable and user-friendly source of information.
It is also important for policymakers, physicians, and online rating platforms to create mechanisms that encourage the accumulation of physician ratings to improve the information quality and reliability of rating platforms. Physicians who wish to improve their patient flow should be mindful of online reputation management because reviews about physicians’ interpersonal and clinical skills have significant effects on patients’ physician choices.