Analysis of Online Medical Crowdfunding Based on the Operation of Chinese Nepotist Society — Case Study of Waterdrop Medical Crowdfunding Platform

. With the continuous development of Internet technology, traditional charities are gradually combining with the Internet, providing a convenient and efficient fundraising channel for individuals in urgent need of personal medical treatment for serious diseases. Some researchers have conducted relevant studies on the renqing operation on social media and online medical crowdfunding platforms respectively; however, there are still some gaps in the research on the renqing operation of online medical crowdfunding. Therefore, this study selected Waterdrop, an online medical crowdfunding platform that mainly relies on WeChat, a social media platform with strong ties, as a case study, exploring the influence of Chinese traditional nepotist society on the effect of online crowdfunding from three aspects: communication behavior, trust mechanism and crowdfunding content. The study found that while renqing operations helped online crowdfunding in terms of fundraising and forwarding, they also limited the further and wider diffusion of crowdfunding information to a certain extent, reflecting the limitations of relying on WeChat to spread the information. In addition, to improve the operational mechanism of online crowdfunding and its effect, it is necessary for the platform itself, social media, society, and other aspects to make efforts.


Introduction
At present, in China's medical insurance system, the actual expenses paid by individuals account for a high proportion, the personal medical burden is heavy, and the insurance fundamentals are narrow.Some groups have no medical security, and there are not a few cases of poverty due to illness among low-income groups [1].The development of Internet crowdfunding creates a new situation of bottom-up public welfare assistance for individuals or families with serious disease fundraising needs.How to use social media platforms to spread fundraising information so as to obtain the best fundraising results is of great significance to fundraisers, and involves various subjects such as donors, platforms, and society.Current research related to Chinese nepotist society has looked at how renqing operated in social media: seeking help from online friends in the ideological exchange of renqing, which involves the judgment of guanxi, the norm of bao, the appraisal of costs, and other actions inside the network [2]; connecting network size to diversity and trust in the mobile social network WeChat from the perspective of personal ties, group ties and latent ties [3].Most research on online medical crowdfunding platforms focuses on trust construction, information forwarding behavior, business model, etc., but there is still a gap in the research on the effect of nepotist society on online crowdfunding [4][5][6].This study selected Waterdrop, an online medical crowdfunding platform that relies heavily on WeChat, a social media platform for information dissemination, for case analysis.Waterdrop needs a radiating network of acquaintances.It begins with the influence of strong ties such as those between relatives and friends and gradually expands to weak ties.Besides, it relies on the affection and credibility between acquaintances.And the characteristics of the acquaintance communication mechanism have a great influence on the behavior of the entrant.This article will discuss the performance of medical crowdfunding in China from the perspectives of communication behavior, trust mechanism and crowdfunding content, three aspects under the influence of traditional nepotist society.

Waterdrop company
Waterdrop is a domestic Internet service platform for personal help with serious diseases.It plays the role of "emergency relief" through mobile Internet technology to help patients and families who are in trouble with serious diseases.Fundraisers can initiate medical aid with the help of Shuiduchou.com and share it through social networks such as WeChat.Caring people can help by forwarding fundraising links or paying online.The communication of the Waterdrop crowdfunding link is dependent on WeChat, a social media platform typically featuring strong ties.Under the cultural context of renqing operation in China, its diffusing and fundraising effects are quite influenced by both.

Link forwarding
The first way that can help fundraisers is through information diffusers who help repost the crowdfunding link to attract more potential donors' attention, thus increasing the possibility of making donations.When audiences click on WeChat moments, they will see the link to crowdfunding information forwarded by some WeChat friends.There are always some words accompanied by the link, emphasizing the relationship between the fundraiser and the person who forwarded it, which narrows people's psychological distance, and promotes active forwarding behavior based on trust [5].

Real-name authentication
When audiences click into the crowdfunding link, they can see that in addition to the traditional information authentication interface, such as the patient's name, disease, receiving account and other proof materials, Waterdrop has a list of proofs.Patients' relatives and friends can help patients confirm information through their own real-name authentication.The purpose of both types of authentication is to establish credibility between acquaintances, which helps the public judge the truth of the event and effectively resist group panic and circle breaches of trust [7].

Sad story and pictures
Besides, crowdfunding information on social media often reflects the plight and pain of the aid recipients with both pictures and stories.The emotions such as sympathy and pity that may be aroused by the information can spread quickly in the interpersonal network.Thus, the hardship of a family is known by thousands of online friends, improving the possibility of being assisted.On the other hand, for example, there is a bullet-screen area in the lower left corner of the crowdfunding link, which constantly displays the donation situation of other friends, showing who donated how much money a few minutes ago and how many times he or she helped forward this link.Or, for the donation ranking at the bottom of the crowdfunding link, friends who donated will be ranked according to the amount of their donations.In this process, an individual's decision to donate can be transmitted through social networks to his or her social circle, making networking embedded in social media a form of social pressure to some extent, increasing the likelihood of "peer-to-peer fundraising" and encouraging his or her friends to give generously [8].

The limitations under the impact of nepotist society
Chinese society is an individual-centered social network, and the superposition of social networks forms a Chinese "acquaintance society" [7].WeChat is a social network of acquaintances.Based on the authentication mechanism on both sides, the mutual acceptance of both users is the basis of the contact relationship.The user has some social connections in reality, which are the basis for the establishment of the WeChat network, which indicates that the "strong ties" category comprises the majority of individual WeChat friends [9].They tend to have relatively stable emotional awareness and strong emotional adhesion, sometimes leading to the blurring of the "sense of boundary" between subjects.Emotion and renqing are exchange behaviors based on strong ties, which to some extent reflect the reciprocal behaviors that people attach importance to in the communication process [10].However, reciprocal relationships should not be overused; too much renqing burden will hinder normal and orderly interpersonal communication.
Firstly, relationship strength is the primary factor affecting medical forwarding behavior [5].In his book Rural China, Fei Xiaotong used "differential pattern" to describe the social relations among people in Chinese society.In a differential pattern, social relations are gradually pushed away from one person to another and personal connections are increased.Social relations take human nodes and personal connections as a network, which contains trust relationships.When the connection with the center is weaker and weaker, the trust degree is lower and lower [10].This is reflected in the process of crowdfunding link forwarding: When the interpersonal connectivity of social media gets weaker, the spread of information will be limited to a certain range of social ties.In addition, in online medical crowdfunding, help-seekers are generally people with relatively weak status conditions in all aspects, and most of their friends in both real life and WeChat are the same as them, with lower education, a single lifestyle, and relatively poor economic conditions.The strong homogeneity of the circle of friends makes the information circulate continuously in the hands of people with a small amount of social resources [5].It is difficult to break the real differential pattern of the circle of friends, so it is difficult to achieve the ideal fundraising effect.
Secondly, active forwarding or helping behaviors based on trust often show egoistic or altruistic motives: on the one hand, they give substantial help to others to realize altruism; on the other hand, they establish a good image of kindness and love in WeChat moments by participating in public welfare, so as to realize egoism in the construction of their social reputation [4].However, the passive forwarding or helping behaviors based on the operation of renqing is more a kind of forced behavior produced under pressure and moral kidnapping; in essence, they are a kind of human burden and consumption [5].In WeChat, a semi-closed platform, strong ties are also regarded as a bonding social capital.Under the principle of reciprocity, sometimes out of consideration for "mianzi" or "reniqng", people are often forced to forward the link or donation under the invisible pressure of relatives or bosses, and often have no way to refuse, thus overdrawing their contacts and human relations [5].In addition, conformity pressure is much greater in strong ties than in weak ties, which will also lead to passive assistance behaviors [11].
Thirdly, the influence of the circle of friends weakens with the increase of the complexity of the social network, and overreliance on the social mechanism of acquaintances is easy to cause trust overdraft.In crowdfunding links, help-seekers achieve emotional mobilization of help-seeking texts through "selfpresentation" in two ways: self-identity construction and tragic narrative [4].A sad, pathetic and helpful image is presented in the WeChat moment to arouse the emotional identification of participants.However, by relying on the mixed business model of "public crowdfunding + commercial insurance", Waterdrop has buried no small hidden danger in its communication mode of cracking fundraising by using acquaintances' social circles [6].Excessive commercialization makes Waterdrop's "story ghostwriting" business gradually rise, with more and more homogenous sad stories filled in the audience's WeChat moments.The wrapping and imprisonment of homogenized information will make the information source single, causing the information to narrow, and make the views of the group converge and lead to group polarization [12].Additionally, as a private space, the WeChat moment mainly aims to share private information, while the participants of online medical crowdfunding make the private space public by bombarding the audiences' screen with a large amount of the same information at the same time.After receiving similar content continuously, the audience is prone to reading fatigue, resulting in trust consumption and reducing the active forwarding behavior based on trust.

Suggestions
Firstly, the help-seeker can choose diffusion channels to alleviate the limitation of spreading in a certain range of social ties, and disclosing more social media information can help alleviate information asymmetry [13].Compared with WeChat, platforms such as Weibo and Facebook belong to social information networks, whose main function is to spread information and connect users through common topics [9].Wechat's circle of friends is affected by strong ties; when the real human connection is weakened, the communication effect will be greatly reduced.Although platforms such as Weibo can spread information widely and quickly, it is difficult to further promote donation behavior due to the influence of weak ties.At present, no media has an unparalleled effect on social communication, so different social media should complement each other and cooperate with each other to achieve better communication and a greater donation effect [5].In addition to diffusion channels, WeChat official accounts can also serve as a useful tool to help solve this problem.WeChat's public account is a "pointto-plane" post model that correlates the poster and receiver and ensures that information reaches subscribers and is persistent.For instance, Tecent Charity establishes a micro-community for users on WeChat and offers a bridge for user contact through fundraising campaigns like "My Charity Story" and online discussion activities.The public accounts and users maintain a strong engagement by engaging in a variety of activities, turning the weak links of "posting-receiving" into the strong ties of "posting-receiving-feedback" in the virtual world.
Secondly, gradually establish and perfect the trust mechanism from emotional trust to institutional trust.The participants of public welfare crowdfunding in the context of WeChat social media are mainly acquaintances or acquaintances of acquaintances, which is the integration of WeChat social media and Chinese traditional nepotist society.The internal trust that affects donation behavior can be divided into emotional trust, cognitive trust, and institutional trust, and the three kinds of trust are integrated and influence each other [10].Starting from the Waterdrop platform, the use of words, pictures, and other forms of emotional rendering, to mobilize the emotions of actors belongs to emotional trust; Cognitive trust is when a person uses his or her personal experience as a guide to action, such as helping a fundraiser conduct authentication with their real name or directly donating after being inspired by the philanthropic atmosphere of a circle of friends; the external image and internal management of the platform itself will help the actors make decisions, which belongs to institutional trust.Emotional trust, however, is easily broken and is closely related to benefits and reciprocity.It requires positive responses every time to maintain relative stability.Institutional trust is the support of emotional trust and cognitive trust, as well as an external guarantee [10].Therefore, emotional trust needs to be supplemented by institutional trust to promote the healthy development of online public crowdfunding.Waterdrop online medical crowdfunding platform should strengthen its own credibility construction; improve the certification and review process of fundraising materials; realize transparent management of fund flow; Establish an open and transparent monitoring and feedback mechanism for public charity crowdfunding.For social media like WeChat, QQ and Weibo, they should assume their social responsibilities, consider the property loss and emotional loss caused by bad public charity crowdfunding to the public, and maintain the image of the platform.For example, a risk warning Windows are set on WeChat and QQ chat tools; streams are restricted on Weibo and "This Weibo is a false fundraising message" is marked.Serious false messages must be screened or deleted in time.Lastly, the government also plays an important role in building institutional trust.It must formulate relevant laws and regulations to close the loopholes in Internet public welfare crowdfunding and promote the establishment of unified audit standards for the industry.Besides, establishing a third-party platform for feedback and supervision of public welfare, comprehensively monitoring the public welfare process, actively guiding the standardization of public welfare platforms, and reducing the occurrence of donation fraud [1].
Thirdly, in order to alleviate the human consumption caused by the flooding of homogeneous sad stories in the process of crowdfunding, the online crowdfunding platform should strengthen the check and review of public welfare crowdfunding texts [1] and clarify the commercial nature of the platform itself.Crowdfunding platforms should not pursue "performance" too much and induce users to raise and donate money.Instead of providing guidance for writing sad stories, crowdfunding platforms should reject false and exaggerated bad public welfare crowdfunding information from the source, establish an efficient content review platform and mechanism, and monitor public welfare crowdfunding information in real time to ensure its accuracy and authenticity.Monitoring irregularities in the fundraising process and promptly taking warning and governance measures.Secondly, for the online medical crowdfunding platform, it should first clarify the nature of the platform itself in the process of external publicity, avoid misleading the public with confusing propaganda statements, and refuse to consume public goodwill in the name of public welfare [6].Besides, it should clarify the business scope of its public service section and commercial section and distinguish the profit boundary of the commercial section so as to prevent human consumption caused by excessive commercialization and reduce the role of strong ties in human service operations.Also, rather than how to use a tragic narrative to gain sympathy, crowdfunding platforms should think about how they can give fundraisers more practical help, such as one-on-one guidance on everything from the fundraiser application to the cash withdrawal --real help to an older or hard-to-use user.

Conclusion
This study found that the renqing operation contributes positively to the fundraising effect of online medical crowdfunding, which relies heavily on social media platform with strong ties, but also produces some limitations.This can be explained by the three aspects discussed in this paper.First of all, from the aspect of communication behavior, the operation of renqing has narrowed the psychological distance between fundraisers and their friends in the circle of friends.Compared with strangers, the audience is more likely to help.But at the same time, the range of information dissemination is also limited to a certain circle of interpersonal communication due to the diminished closeness of the fundraiser; and the homogeneity of the circle of friends sometimes does not allow those who really need help to access useful social resources.This phenomenon can be alleviated through the diffusion of communication channels, using different types of social media to cooperate in communication.Secondly, from the aspect of trust mechanism, although the friend's real name authentication helps establish trust mechanism, however, the operation of renqing is based on the principle of reciprocity.Sometimes, the audiences will be forced by social pressure or consideration of renqing, mianzi, and other factors to passively forward fundraising links or donations, which is a consumption of renqing oppositely.Therefore, it is necessary to establish institutional trust to support emotional trust.Thirdly, from the aspect of crowdfunding content, while arousing the audience's empathy, the commercial operation of sad narration also weakens the audience's patience.The platform needs to strengthen the supervision and review of this and clarify the boundary between business and public welfare.
From the perspective of nepotist society, this study explores its influence on the effect of online medical crowdfunding, analyzes its advantages and disadvantages, proposes corresponding solutions, and integrates social studies with mass media communication.To some extent, it fills the gap in the current research on the communication impact of online crowdfunding platforms.However, the research in this paper also has some limitations, for example, it only focuses on the forwarding and donation behavior of the WeChat moments, and does not involve the relevant research of WeChat groups and "one-to-one" chat as the information diffusion channel.Compared with the openness of the WeChat moments, individual chats are more private, and their purpose and directivity are clearer.The operation and influence of human relations in this communication relationship are different from those in the WeChat moments.They can be further analyzed in detail as a future research field.