Econ Papers Daily / 期刊论文
超越患者叙事：中国医疗众筹中的关系性证言与结果
Beyond the patient's story: Relational testimonies and medical crowdfunding outcomes in China
摘要
Medical crowdfunding has emerged as a critical financing channel for medical expenses, especially among populations with inadequate health insurance coverage. However, a substantial number of campaigns fail to meet their fundraising targets, partly attributable to credibility concerns stemming from information asymmetry. Drawing on a unique dataset from a major online medical crowdfunding platform in China, this study examines how specific narrative strategies embedded in relational testimonies influence fundraising outcomes. We find that three credibility enhancing narrative strategies, including identity construction, situation supplement, and encouragement or blessing, are positively associated with the total funds raised. Credibility-enhancing strategies are especially effective in attracting large donations (>30 yuan) from donors with closer social ties to the patient, whereas direct appeals are critical for soliciting small donations (≤30 yuan) from more socially distant donors. Notably, situation supplement strategy exerts a particularly strong effect among rural patients. To address endogeneity and establish causality, we employ a difference-in-differences design that tracks donation patterns around the posting of the first testimony. We define a testimony as “persuasive” if it combines a direct appeal with at least one credibility-enhancing strategy and find that persuasive testimonies lead to a significant and persistent increase of approximately 14% in small donations within the hour following their posting, relative to non-persuasive testimonies. The persuasive effect tends to strengthen with the social distance between the testifier and the patient, operates consistently across different posting times, and is not driven by the patient's inherent social capital. Our findings highlight relational testimonies as a socially constructed mechanism for mitigating credibility deficits, offering implications for understanding how vulnerable populations mobilize financial support to cope with catastrophic health expenditures.
中文摘要
医疗众筹已成为医疗支出的关键融资渠道，尤其是在医疗保险覆盖不足的人群中。然而，大量众筹项目未能达到其筹资目标，部分原因可归因于信息不对称所引发的可信度担忧。本研究基于中国一家主要在线医疗众筹平台的独特数据集，考察关系型证言中所嵌入的特定叙事策略如何影响筹资结果。我们发现，三种可信度增强型叙事策略——包括身份建构、情境补充以及鼓励或祝福——与筹资总额呈正相关。可信度增强策略在吸引与患者社会关系更紧密的捐赠者进行大额捐赠（>30元）方面尤为有效，而直接呼吁对于争取社会距离更远的捐赠者进行小额捐赠（≤30元）则至关重要。值得注意的是，情境补充策略在农村患者中效果尤为显著。为解决内生性问题并确立因果关系，我们采用双重差分设计，追踪第一条证言发布前后的捐赠模式。我们将证言定义为“有说服力的”，如果它结合了直接呼吁与至少一种可信度增强策略；我们发现，相对于非说服性证言，有说服力的证言在其发布后一小时内使小额捐赠显著且持续地增加约14%。这种说服效应倾向于随着证言发布者与患者之间社会距离的增大而增强，在不同发布时间下均保持一致，且并非由患者固有的社会资本所驱动。我们的发现凸显了关系型证言作为一种社会建构机制在缓解可信度缺失方面的作用，为理解弱势群体如何动员财务支持以应对灾难性医疗支出提供了启示。