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Online medical crowdfunding (OMC) has attracted massive attention and participation in China. Despite its goal to lift the financial burden caused by expensive medical expenditure, little has been done to evaluate its impact on healthcare inequality. We examine the social consequences of OMC based on a large random sample extracted from one of the most widely-used OMC platforms in China. Our analysis shows that a disproportionally high percentage of fundraising campaigns are launched for patients with low socioeconomic status suffering from various illnesses, including many rare diseases. These findings suggest that OMC plays a positive role in providing an alternative channel for disadvantaged patients under the current health insurance system. We further examine whether and the extent to which the narrative style of solicitation text—fundraising campaign description—influences fundraising outcomes using natural language processing (NLP). The results show that expressions conveying optimism tend to result in a higher completion ratio, whereas descriptions engaging in moral mobilization or focusing on financial burden tend to have a negative impact on fundraising outcomes.


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Influence of Narrative Strategies on Fundraising Outcome: An Exploratory Study of Online Medical Crowdfunding

Show Author's information Lu Zheng1( )Lihui Jiang1
Department of Sociology, Tsinghua University, Beijing 100084, China

Abstract

Online medical crowdfunding (OMC) has attracted massive attention and participation in China. Despite its goal to lift the financial burden caused by expensive medical expenditure, little has been done to evaluate its impact on healthcare inequality. We examine the social consequences of OMC based on a large random sample extracted from one of the most widely-used OMC platforms in China. Our analysis shows that a disproportionally high percentage of fundraising campaigns are launched for patients with low socioeconomic status suffering from various illnesses, including many rare diseases. These findings suggest that OMC plays a positive role in providing an alternative channel for disadvantaged patients under the current health insurance system. We further examine whether and the extent to which the narrative style of solicitation text—fundraising campaign description—influences fundraising outcomes using natural language processing (NLP). The results show that expressions conveying optimism tend to result in a higher completion ratio, whereas descriptions engaging in moral mobilization or focusing on financial burden tend to have a negative impact on fundraising outcomes.

Keywords: online medical crowdfunding (OMC), narrative, fundraising outcome, healthcare inequality

References(92)

[1]

L. S. Berliner and N. J. Kenworthy, Producing a worthy illness: Personal crowdfunding amidst financial crisis, Social Science &Medicine, vol. 187, pp. 233–242, 2017.

[2]
S. Woolley, American health care tragedies are taking over crowdfunding, Bloomberg, https://www.bloomberg.com/news/articles/2017-06-12/america-s-health-carecrisis-is-a-gold-mine-for-crowdfunding, 2017.
[3]
J. Snyder, Crowdfunding for medical care: ethical issues in an emerging health care funding practice, Hastings Center Report, vol. 46, no. 6, pp. 36–42, 2016.
DOI
[4]
GoFundMe, Get help with medical fundraising, https://www.gofundme.com/start/medical- fundraising, 2022.
[5]
N. Kenworthy, Z. Dong, A. Montgomery, E. Fuller, and L. Berliner, A cross-sectional study of social inequities in medical crowdfunding campaigns in the United States, PLoS One, vol. 15, no. 3, p. e0229760, 2020.
DOI
[6]
M. Lukk, E. Schneiderhan, and J. Soares, Worthy? Crowdfunding the Canadian health care and education sectors, Canadian Review of Sociology, vol. 55, no. 3, pp. 404–424, 2018.
DOI
[7]
K. Xu and X. Wang, “Kindhearted people, please save my family”: Narrative strategies for new media medical crowdfunding, Health Communication, vol. 35, no. 13, pp. 1605–1613, 2020.
DOI
[8]

T. M. Paulus and K. R. Roberts, Crowdfunding a “real-life superhero”: The construction of worthy bodies in medical campaign narratives, Discourse,Context &Media, vol. 21, pp. 64–72, 2018.

[9]

N. J. Kenworthy, Crowdfunding and global health disparities: An exploratory conceptual and empirical analysis, Globalization and Health, vol. 15, no. 1, p. 71, 2019.

[10]

J. Sisler, Crowdfunding for medical expenses, Canadian Medical Association Journal, vol. 184, no. 2, pp. E123–E124, 2012.

[11]

I. P. Coutrot, R. Smith, and L. Cornelsen, Is the rise of crowdfunding for medical expenses in the United Kingdom symptomatic of systemic gaps in health and social care, Journal of Health Services Research &Policy, vol. 25, no. 3, pp. 181–186, 2020.

[12]

J. Snyder, M. Zenone, V. Crooks, and N. Schuurman, What medical crowdfunding campaigns can tell us about local health system gaps and deficiencies: Exploratory analysis of British Columbia, Canada, Journal of Medical Internet Research, vol. 22, no. 5, p. e16982, 2020.

[13]

A. J. He and S. Wu, Towards universal health coverage via social health insurance in China: Systemic fragmentation, reform imperatives, and policy alternatives, Applied Health Economics and Health Policy, vol. 15, no. 6, pp. 707–716, 2017.

[14]

L. Li and H. Fu, China’s health care system reform: Progress and prospects, The International Journal of Health Planning and Management, vol. 32, no. 3, pp. 240–253, 2017.

[15]
Chinese Health Statistics Yearbook 2019, http://www.nhc.gov.cn/mohwsbwstjxxzx/tjtjnj/202106/04bd2ba9592f4a70b78d80ea50bfe96e/files/e6401c1c240f45b9bf054d929eaa9e89.pdf, 2019.
[16]

K. Dong, Medical insurance system evolution in China, China Economic Review, vol. 20, no. 4, pp. 591–597, 2009.

[17]

Y. Qiu, Development of China’s healthcare system in the past seventy years: Review and analysis, Chinese Social Security Review, vol. 3, no. 1, pp. 89–101, 2019.

[18]

Y. Meng, X. Zhang, and J. Han, The impact of medical insurance programmes on the health of the insured: Evidence from China, The International Journal of Health Planning and Management, vol. 35, no. 3, pp. 718–734, 2020.

[19]

Q. Meng, H. Fang, X. Liu, B. Yuan, and J. Xu, Consolidating the social health insurance schemes in China: towards an equitable and efficient health system, The Lancet, vol. 386, no. 10002, pp. 1484–1492, 2015.

[20]
National Bureau of Statistics, Report of migrant workers, (in Chinese), http://www.stats.gov.cn/tjsj/zxfb/202004/t20200430_1742724.html, 2019.
[21]

P. Qiu, Y. Yang, J. Zhang, and X. Ma, Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China, BMC Public Health, vol. 11, p. 520, 2011.

[22]

J. Mou, J. Cheng, D. Zhang, H. Jiang, L. Lin, and S. M. Griffiths, Health care utilization amongst Shenzhen migrant workers: Does being insured make a difference, BMC Health Service Research, vol. 9, p. 214, 2009.

[23]

Y. Peng, W. Chang, H. Zhou, H. Hu, and W. Liang, Factors associated with health-seeking behaviors among migrant workers in Beijing, China, BMC Health Service Research, vol. 10, p. 69, 2010.

[24]
The report of 2018 China commercial health insurance development index (large and medium-sized cities), http://pdf.dfcfw.com/pdf/H3_AP201810171215095058_1.pdf, 2018.
[25]

P. Fang, Z. Pan, X. Zhang, X. Bai, Y. Gong, and X. Yin, The effect of critical illness insurance in China, Medicine, vol. 97, no. 27, p. e11362, 2018.

[26]
National Development and Reform Commission; National Health and Family Planning Commission; Ministry of Finance; Ministry of Human Resources and Social Security; Ministry of Civil Affairs; China Insurance Regulatory Commission, Guidance on the implementation of catastrophic diseases insurance for urban and rural residents, http://www.gov.cn/jrzg/2012-08/30/content_2213783.htm, 2012.
[27]

H. Li and L. Jiang, Catastrophic medical insurance in China, The Lancet, vol. 390, no. 10104, pp. 1724–1725, 2017.

[28]

S. Zhao, X. Zhang, W. Dai, Y. Ding, J. Chen, and P. Fang, Effect of the catastrophic medical insurance on household catastrophic health expenditure: Evidence from China, Gaceta Sanitaria, vol. 34, no. 4, pp. 370–376, 2020.

[29]

A. Li, Y. Shi, X. Yang, and Z. Wang, Effect of critical illness insurance on household catastrophic health expenditure: The latest evidence from the National Health Service survey in China, International Journal of Environmental Research and Public Health, vol. 16, no. 24, p. 5086, 2019.

[30]

Z. Ying, L. Gong, and C. Li, An update on China’s national policies regarding rare diseases, Intractable &Rare Diseases Research, vol. 10, no. 3, pp. 148–153, 2021.

[31]
M. Zhao, More than half of rare disease drugs are included in medical insurance, and the adjustment of medical insurance will be appropriately tilted in the future, (in Chinese), http://www.jksb.com.cn/html/news/hot/2022/1024/180695.html, 2022.
[32]
The National Healthcare Security Administration explores guarantee mechanism of drugs for rare diseases and encourages the introduction of commercial insurance, (in Chinese), https://www.cn-healthcare.com/articlewm/20201015/content-1153246.html, 2020.
[33]
The State Council Information Office held a press conference on the implementation of the health poverty alleviation project, (in Chinese), http://www.scio.gov.cn/xwfbh/xwbfbh/wqfbh/33978/34697/index.htm, 2016.
[34]

J. Ren, V. Raghupathi, and W. Raghupathi, Understanding the dimensions of medical crowdfunding: A visual analytics approach, Journal of Medical Internet Research, vol. 22, no. 7, p. e18813, 2020.

[35]

M. J. Renwick and E. Mossialos, Crowdfunding our health: Economic risks and benefits, Social Science &Medicine, vol. 191, pp. 48–56, 2017.

[36]

A. V. Duynhoven, A. Lee, R. Michel, J. Snyder, V. Crooks, P. Chow-White, and N. Schuurman, Spatially exploring the intersection of socioeconomic status and Canadian cancer-related medical crowdfunding campaigns, BMJ Open, vol. 9, no. 6, p. e026365, 2019.

[37]

J. Snyder, A. Mathers, and V. A. Crooks, Fund my treatment!: A call for ethics-focused social science research into the use of crowdfunding for medical care, Social Science &Medicine, vol. 169, pp. 27–30, 2016.

[38]

C. Cheng and Y. F. Ren, The paradox of seeking help: Socio-economic status differences in medical crowdfunding in the era of mobile internet, Chinese Journal of Sociology, vol. 42, no. 1, pp. 124–156, 2022.

[39]
J. Huang, H. Shen, Q. Cao, L. Cai, and X. Cheng, How medical crowdfunding helps people? A large-scale case study on the Waterdrop fundraising, Proceedings of the International AAAI Conference on Web and Social Media, vol. 15, no. 1, pp. 220–229, 2021.
DOI
[40]

J. Nahapiet and S. Ghoshal, Social capital, intellectual capital, and the organizational advantage, Academy of Management Review, vol. 23, no. 2, pp. 242–266, 1998.

[41]

I. Borst, C. Moser, and J. Ferguson, From friendfunding to crowdfunding: Relevance of relationships, social media, and platform activities to crowdfunding performance, New Media &Society, vol. 20, no. 4, pp. 1396–1414, 2018.

[42]

Y. Peng, Kinship networks and entrepreneurs in China’s transitional economy, American Journal of Sociology, vol. 109, no. 5, pp. 1045–1074, 2004.

[43]

G. D. Saxton and L. Wang, The social network effect: The determinants of giving through social media, Nonprofit and Voluntary Sector Quarterly, vol. 43, no. 5, pp. 850–868, 2014.

[44]

E. Mollick, The dynamics of crowdfunding: An exploratory study, Journal of Business Venturing, vol. 29, no. 1, pp. 1–16, 2014.

[45]

J. S. Coleman, Social capital in the creation of human capital, American Journal of Sociology, vol. 94, pp. S95–S120, 1988.

[46]

J. Morduch, The microfinance promise, Journal of Economic Literature, vol. 37, no. 4, pp. 1569–1614, 1999.

[47]

M. K. Poetz and M. Schreier, The value of crowdsourcing: Can users really compete with professionals in generating new product ideas, Journal of Product Innovation Management, vol. 29, no. 2, pp. 245–256, 2012.

[48]
Y. Chen, R. Dai, J. Yao, and Y. Li, Donate time or money? The determinants of donation intention in online crowdfunding, Sustainability, vol. 11, no. 16, p. 4269, 2019.
DOI
[49]

Y. Z. Li, T. L. He, Y. R. Song, Z. Yang, and R. T. Zhou, Factors impacting donors’ intention to donate to charitable crowd-funding projects in China: A UTAUT-based model, Information,Communication &Society, vol. 21, no. 3, pp. 404–415, 2018.

[50]

T. Wang, Y. Li, M. Kang, and H. Zheng, Exploring individuals’ behavioral intentions toward donation crowdfunding: Evidence from China, Industrial Management &Data Systems, vol. 119, no. 7, pp. 1515–1534, 2019.

[51]
H. Jiao, L. Qian, T. Liu, and L. Ma, Why do people support online crowdfunding charities? A case study from China, Frontiers in Psychology, vol. 12, p. 582508, 2021.
DOI
[52]

K. Healy, Altruism as an organizational problem: The case of organ procurement, American Sociological Review, vol. 69, no. 3, pp. 387–404, 2004.

[53]

V. A. Shaffer, E. S. Focella, A. Hathaway, L. D. Scherer, and B. J. Zikmund-Fisher, On the usefulness of narratives: An interdisciplinary review and theoretical model, Annals of Behavioral Medicine, vol. 52, no. 5, pp. 429–442, 2018.

[54]

R. J. Shiller, Narrative economics, American Economic Review, vol. 107, no. 4, pp. 967–1004, 2017.

[55]

R. Adaval and R. S. Wyer Jr., The role of narratives in consumer information processing, Journal of Consumer Psychology, vol. 7, no. 3, pp. 207–245, 1998.

[56]

A. S. Mattila, The role of narratives in the advertising of experiential services, Journal of Service Research, vol. 3, no. 1, pp. 35–45, 2000.

[57]

K. A. Correa, B. T. Stone, M. Stikic, R. R. Johnson, and C. Berka, Characterizing donation behavior from psychophysiological indices of narrative experience, Frontiers in Neuroscience, vol. 9, p. 301, 2015.

[58]

R. Garud, H. A. Schildt, and T. K. Lant, Entrepreneurial storytelling, future expectations, and the paradox of legitimacy, Organization Science, vol. 25, no. 5, pp. 1479–1492, 2014.

[59]

J. P. Cornelissen and J. S. Clarke, Imagining and rationalizing opportunities: Inductive reasoning, and the creation and justification of new ventures, Academy of Management Review, vol. 35, no. 4, pp. 539–557, 2010.

[60]

S. Manning and T. A. Bejarano, Convincing the crowd: Entrepreneurial storytelling in crowdfunding campaigns, Strategic Organization, vol. 15, no. 2, pp. 194–219, 2016.

[61]
F. Cappa, M. Pinelli, R. Maiolini, and M. I. Leone, “Pledge” me your ears! The role of narratives and narrator experience in explaining crowdfunding success, Small Business Economics, vol. 57, pp. 953–973, 2020.
DOI
[62]
T. Mitra and E. Gilbert, The language that gets people to give: Phrases that predict success on kickstarter, in Proc. 17th ACM Conference on Computer Supported Cooperative Work Social Computing, Baltimore, MD, USA, 2014, pp. 49–61.
DOI
[63]

M. Herzenstein, S. Sonenshein, and U. M. Dholakia, Tell me a good story and I may lend you money: The role of narratives in peer-to-peer lending decisions, Journal of Marketing Research, vol. 48, pp. S138–S149, 2011.

[64]

K. D. Elsbach and R. M. Kramer, Assessing creativity in Hollywood pitch meetings: Evidence for a dual-process model of creativity judgments, Academy of Management Journal, vol. 46, no. 3, pp. 283–301, 2003.

[65]
A. Gorbatai and L. Nelson, The narrative advantage: Gender and the language of crowdfunding, https://faculty.haas.berkeley.edu/gorbatai/working%20papers%20and%20word/Crowdfunding-GenderGorbataiNelson.pdf, 2015.
DOI
[66]

S. Manning and T. A. Bejarano, Convincing the crowd: Entrepreneurial storytelling in crowdfunding campaigns, Strategic Organization, vol. 15, no. 2, pp. 194–219, 2017.

[67]

A. Rama, C. Jiang, S. Johan, H. Liu, and Y. Mai, Religious and social narratives and crowdfunding success, Journal of International Financial Markets,Institutions and Money, vol. 80, p. 101595, 2022.

[68]

M. Moradi and V. Badrinarayanan, The effects of brand prominence and narrative features on crowdfunding success for entrepreneurial aftermarket enterprises, Journal of Business Research, vol. 124, pp. 286–298, 2021.

[69]

A. Majumdar and I. Bose, My words for your pizza: An analysis of persuasive narratives in online crowdfunding, Information &Management, vol. 55, no. 6, pp. 781–794, 2018.

[70]
J. G. Kim, H. Hong, and K. Karahalios, Understanding identity presentation in medical crowdfunding, in Proc. 2018 CHI Conference on Human Factors in Computing Systems, Montreal, Canada, 2018, pp. 1–12.
DOI
[71]

B. R. Schlenker and M. F. Weigold, Interpersonal processes involving impression regulation and management, Annual Review of Psychology, vol. 43, pp. 133–168, 1992.

[72]

M. R. Leary and R. M. Kowalski, Impression management: A literature review and a two-component model, Psychological Bulletin, vol. 107, no. 1, pp. 34–47, 1990.

[73]
C. Geertz, Local Knowledge: Further Essays in Interpretive Anthropology. New York, NY, USA: Basic books, 1983.
[74]
L. K. Larkey and M. Hecht, A model of effects of narrative as culture-centric health promotion, Journal of Health Communication, vol. 15, no. 2, pp. 114–135, 2010.
DOI
[75]

J. A. Piliavin and H. -W. Charng, Altruism: A review of recent research, Annual Review of Sociology, vol. 16, pp. 27–65, 1990.

[76]

P. G. Schervish and J. J. Havens, Social participation and charitable giving: A multivariate analysis, Voluntas: International Journal of Voluntary and Nonprofit Organizations, vol. 8, no. 3, pp. 235–260, 1997.

[77]

J. Tobin, Estimation of relationships for limited dependent variables, Econometrica:Journal of the Econometric Society, vol. 26, no. 1, pp. 24–36, 1958.

[78]

M. Zhou, H. Wang, X. Zeng, P. Yin, J. Zhu, W. Chen, X. Li, L. Wang, L. Wang, Y. Liu, et al., Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: A systematic analysis for the global burden of disease study 2017, The Lancet, vol. 394, no. 10204, pp. 1145–1158, 2019.

[79]
N. Lacetera, M. Macis, and A. Mele, Viral altruism? Charitable giving and social contagion in online networks, Sociological Science, vol. 3, pp. 234–270, 2016.
DOI
[80]
K. Kristofferson, K. White, and J. Peloza. The nature of slacktivism: How the social observability of an initial act of token support affects subsequent prosocial action, Journal of Consumer Research, vol. 40, no. 6, pp. 1149–1166, 2014.
DOI
[81]

L. Larrimore, L. Jiang, J. Larrimore, D. Markowitz, and S. Gorski, Peer to peer lending: The relationship between language features, trustworthiness, and persuasion success, Journal of Applied Communication Research, vol. 39, no. 1, pp. 19–37, 2011.

[82]
B. Duncan, A theory of impact philanthropy, Journal of Public Economics, vol. 88, pp. 2159–2180, 2004.
DOI
[83]

V. Kuppuswamy and B. L. Bayus, Does my contribution to your crowdfunding project matter, Journal of Business Venturing, vol. 32, no. 1, pp. 72–89, 2017.

[84]
D. Lowry and Y. Xie, Socioeconomic status and health differentials in China: Convergence or divergence at old ages? http://www.psc.isr.umich.edu/pubs/pdf/rr09-690.pdf,2009.
[85]

J. S. Feinstein, The relationship between socioeconomic status and health: A review of the literature, Milbank Quarterly, vol. 71, no. 2, pp. 279–322, 1993.

[86]

O. V. D. Knesebeck, P. E. Verde, and N. Dragano, Education and health in 22 European countries, Social Science &Medicine, vol. 63, no. 5, pp. 1344–1351, 2006.

[87]

N. E. Adler, T. Boyce, M. A. Chesney, S. Cohen, S. Folkman, R. L. Kahn, and S. L. Syme, Socioeconomic status and health: The challenge of the gradient, American Psychologist, vol. 49, no. 1, pp. 15–24, 1994.

[88]
B. G. Link and J. Phelan, Social conditions as fundamental causes of disease, Journal of Health and Social Behavior, Extra Issue, pp. 80–94, 1995.
DOI
[89]

M. S. Granovetter, The strength of weak ties, American Journal of Sociology, vol. 78, no. 6, pp. 1360–1380, 1973.

[90]

M. S. Granovetter, The strength of weak ties: A network theory revisited, Sociological Theory, vol. 1, pp. 201–233, 1983.

[91]

S. Macintyre, The black report and beyond: What are the issues, Social Science &Medicine, vol. 44, no. 6, pp. 723–745, 1997.

[92]

I. T. Elo, Social class differentials in health and mortality: Patterns and explanations in comparative perspective, Annual Review of Sociology, vol. 35, pp. 553–572, 2009.

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Received: 08 September 2022
Revised: 22 November 2022
Accepted: 23 November 2022
Published: 31 December 2022
Issue date: December 2022

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