Medical crowdfunding for organ transplantation

Breaking Barriers: Advancing the Mission of The Equity in Heart Transplant Project

The Equity in Heart Transplant Project, Inc (TEHTP), a 501(c)(3) public charity founded in 2022, addresses financial and social barriers impeding access to heart transplantation for patients with end-stage heart failure in the United States. Rooted in the World Health Organization's declaration on health as a fundamental right, TEHTP champions equitable care. Financial impediments disproportionately affect minority populations, perpetuating disparities in heart transplant outcomes. Since its inception in 2022, TEHTP has successfully supported 31 patients. Looking ahead, TEHTP aims to influence health policies surrounding insurance coverage through advocacy efforts and expand assistance to posttransplant care. Past accomplishments and future goals exemplify the organization's commitment to eradicating systemic barriers and ensuring that poverty does not become a death sentence for transplant patients.

The Wallet Biopsy: Medical Crowdfunding for Heart Transplantation

Financial considerations continue to impact access to heart transplantation. Transplant recipients face various costs, including, but not limited to, the index hospitalization, immunosuppressive medications, and lodging and travel to appointments. In this study, we sought to describe the state of crowdfunding for individuals being evaluated for heart transplantation. Using the search term heart transplant, 1000 GoFundMe campaigns were reviewed. After exclusions, 634 (63.4%) campaigns were included. Most campaigns were in support of white individuals (57.8%), males (63.1%) and adults (76.7%). Approximately 15% of campaigns had not raised any funds. The remaining campaigns fundraised a median of $53.24 dollars per day. Of the patients, 44% were admitted at the time of the fundraising. Within the campaigns in the United States, the greatest proportions were in the Southeast United States in non-Medicaid expansion states. These findings highlight the significant financial toxicities associated with heart transplantation and the need for advocacy at the governmental and payer levels to improve equitable access and coverage for all.

The role of race and ethnicity in health care crowdfunding: an exploratory analysis

Medical crowdfunding is a key source of financing for individuals facing high out-of-pocket costs, including organ-transplant candidates. However, little is known about racial disparities in campaigning activity and outcomes, or how these relate to access to care. In this exploratory, nationwide, cross-sectional study, we examined racial disparities in campaigning activity across states and the association between US campaigners' race and ethnicity and crowdfunding outcomes using a novel database of organ-transplant-related campaigns, and an algorithm to identify race and ethnicity based on name and geographic location. This analysis suggests that there are racial disparities in individuals' ability to successfully raise requested funds, with Black and Hispanic campaigners fundraising lower amounts and less likely to achieve their monetary goals. We also found that crowdfunding among White, Black, and Hispanic populations exhibits different patterns of activity at the state level, and in relation to race-specific uninsurance and waitlist additions, highlighting potential differences in fundraising need across the 3 groups. Policy efforts should consider not only how inequalities in fundraising ability for associated costs influence accessibility to care but also how to identify clinical need among minorities.

An overview of Fintech applications to solve the puzzle of health care funding: state-of-the-art in medical crowdfunding

Crowdfunding is emerging as an alternative form of funding for medical purposes, with capital being raised directly from a broader and more diverse audience of investors. In this paper, we have systematically researched and reviewed the literature on medical crowdfunding to determine how crowdfunding connects with the health care industry. The health care industry has been struggling to develop sustainable research and business models for economic systems and investors alike, especially in pharmaceuticals. The research results have revealed a wealth of evidence concerning the way crowdfunding is applied in real life. Patients and caregivers utilize web platform-based campaigns all over the world to fund their medical expenses, generally on a spot basis, using donation-based or even reward-based schemes, regardless of the health care system archetype (public, private insurance-based or hybrid). Academics have also focused on funding campaigns and the predictors of success (which range from social behaviour and environment to the basic demographics of the campaigners and their diseases) and on social and regulatory concerns, including heightened social inequality and stigma. While equity crowdfunding is disrupting the way many ventures/businesses seek capital in the market, our research indicates that there are no relevant or consistent data on the practice of medical equity crowdfunding in health care, apart from a few anecdotal cases.

Analysis of text factors impacting donation behavior in public welfare crowdfunding projects

BACKGROUND: The textual description of a public service crowdfunding project is an important factor influencing the audience’s donation behavior, but the existing studies on the textual characteristics of the project are rather scattered. OBJECTIVE: This paper attempts to systematically sort out the characteristics of project texts along the lines of linguistic and non-linguistic factors, clarifying the relationship between the characteristics of project texts, project sources, and social donation behavior. METHODS: Based on Aristotle’s persuasion theory, language factors are measured from three dimensions of appeal to personality, appeal to logic, and appeal to emotion, while other text features unrelated to persuasive language are classified as non-language factors. When discussing the influence path of linguistic and non-linguistic factors on donation behavior, this paper controls the project type to test the moderating role played by the identity characteristics of crowdfunding initiators. RESULTS: The results show that the use of personality-based language (third-person words), logic-based language (money words and quantitative words), and emotion-based language (tone of voice and negative emotions) all have a significant positive effect on the audience’s donation behavior, while the use of second-person words in personality-based language has a negative effect on donation behavior; the identity of the project initiator (project origin) plays a complex and diverse moderating role in the influence of project text features on donation behavior. CONCLUSION: There are obvious differences in the description of different text strategies adopted by the project initiator.

Factors Influencing Donation Intention to Personal Medical Crowdfunding Projects Appearing on MSNS

This purpose of this study is to develop a research model by extending the theory of planned behavior in a new application context, and applies it to investigate the extrinsic factors influencing people’s attitude towards donating to medical crowdfunding projects appearing on mobile social networking sites (MSNS) and their intention to donate. A survey of 356 Chinese users was conducted and structural equation modeling was used to validate the proposed model and hypotheses. The results indicate that project information, retweeter information and MSNS information all have the significant effect on the general attitude towards donating to medical crowdfunding projects, and general attitude positively affects people’s donation intention. In addition, perceived behavioral control also has positive effect on people’s donation intention, while experienced donating to medical crowdfunding projects has negative effect on people’s donation intention. The research findings provide important theoretical and practical implications.

A Disease Identification Algorithm for Medical Crowdfunding Campaigns: Validation Study

Background

Web-based crowdfunding has become a popular method to raise money for medical expenses, and there is growing research interest in this topic. However, crowdfunding data are largely composed of unstructured text, thereby posing many challenges for researchers hoping to answer questions about specific medical conditions. Previous studies have used methods that either failed to address major challenges or were poorly scalable to large sample sizes. To enable further research on this emerging funding mechanism in health care, better methods are needed.

Objective

We sought to validate an algorithm for identifying 11 disease categories in web-based medical crowdfunding campaigns. We hypothesized that a disease identification algorithm combining a named entity recognition (NER) model and word search approach could identify disease categories with high precision and accuracy. Such an algorithm would facilitate further research using these data.

Methods

Web scraping was used to collect data on medical crowdfunding campaigns from GoFundMe (GoFundMe Inc). Using pretrained NER and entity resolution models from Spark NLP for Healthcare in combination with targeted keyword searches, we constructed an algorithm to identify conditions in the campaign descriptions, translate conditions to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes, and predict the presence or absence of 11 disease categories in the campaigns. The classification performance of the algorithm was evaluated against 400 manually labeled campaigns.

Results

We collected data on 89,645 crowdfunding campaigns through web scraping. The interrater reliability for detecting the presence of broad disease categories in the campaign descriptions was high (Cohen κ: range 0.69-0.96). The NER and entity resolution models identified 6594 unique (276,020 total) ICD-10-CM codes among all of the crowdfunding campaigns in our sample. Through our word search, we identified 3261 additional campaigns for which a medical condition was not otherwise detected with the NER model. When averaged across all disease categories and weighted by the number of campaigns that mentioned each disease category, the algorithm demonstrated an overall precision of 0.83 (range 0.48-0.97), a recall of 0.77 (range 0.42-0.98), an F₁ score of 0.78 (range 0.56-0.96), and an accuracy of 95% (range 90%-98%).

Conclusions

A disease identification algorithm combining pretrained natural language processing models and ICD-10-CM code–based disease categorization was able to detect 11 disease categories in medical crowdfunding campaigns with high precision and accuracy.

Crowdfunding campaigns for paediatric patients: A cross-sectional analysis of success determinants

BACKGROUND

We aimed to identify factors of success in medical crowdfunding campaigns on the largest Polish platform: siepomaga.pl.

MATERIAL AND METHODS

All campaigns initialised by patients in the years 2009-2017 were included. The data comprised characteristics of the collections: financial target, raised sum, aim, type of disease, Facebook shares, age category, and the exact collection period. Campaign success was defined as collecting the target sum. Emotional expression on the main photograph was analysed using the Azure Cognitive Service. Logistic regression analysis was performed.

RESULTS

From a total of 2,656 collections, 1,725 (65%) were successful and 42.4 million EUR were raised in total. 2,024 (76.2%) of campaigns were dedicated to children. Successful collections not only received more donations, but were also supported, on average, with larger payments. Fortunate campaigns asked for less money and ended earlier (all p < 0.001). The odds of success were increased by: at least 50 Facebook shares (OR, 95% CI: 1.75, 1.46-2.10), the receiver being a child (1.46, 1.18-1.80), aim: dream come true (1.53, 1.06-2.20) or suffering from a congenital disease (1.34, 1.08-1.67), whereas financial target of no less than 4000 EUR (0.41, 0.34-0.52), aim: rehabilitation (0.51, 0.41-0.64), psychiatric disease (0.52, 0.38-0.71), and maladies of the eye or the ear (0.56, 0.39-0.81) were associated with campaign failure. After adjustment, dominance of happiness on the main photograph decreased the odds of success (0.71, 0.59-0.86).

CONCLUSION

Younger age, lower financial goal, greater exposure on Facebook, aim, disease and emotional expression were associated with success of medical crowdfunding.

Success Factors of Medical Crowdfunding Campaigns: Systematic Review

Background

Medical crowdfunding provides opportunities for individuals who lack financial resources to access the health services that they need. Despite the popularity of medical crowdfunding, the current understanding of the success of medical crowdfunding campaigns is fragmented and inadequate.

Objective

We aimed to comprehensively investigate which factors lead to the success of medical crowdfunding campaigns.

Methods

A search was conducted in PubMed, PsycINFO, Web of Science, ACM Digital Library, and ScienceDirect from 2010 to June 2020. Papers directly and indirectly related to the success of medical crowdfunding campaigns were included. Two reviewers independently extracted information on the success of medical crowdfunding campaigns.

Results

Our search yielded 441 articles, of which 13 met the inclusion criteria. Medical crowdfunding is increasingly attracting academic attention, and most studies leverage text analysis as their research methods; however, there is a lack of consensus on the definition of medical crowdfunding among researchers. Four categories of factors that affect the success of medical crowdfunding were identified: platforms, raisers, donors, and campaigns.

Conclusions

Although some limitations exist in our systematic review, our study captured and mapped literatures of the success of medical crowdfunding campaigns systematically, which can be used as the basis for future research on this topic.

Discussions of Asperger Syndrome on Social Media: Content and Sentiment Analysis on Twitter

Background

On May 8, 2021, Elon Musk, a well-recognized entrepreneur and business magnate, revealed on a popular television show that he has Asperger syndrome. Research has shown that people’s perceptions of a condition are modified when influential individuals in society publicly disclose their diagnoses. It was anticipated that Musk's disclosure would contribute to discussions on the internet about the syndrome, and also to a potential change in the perception of this condition.

Objective

The objective of this study was to compare the types of information contained in popular tweets about Asperger syndrome as well as their engagement and sentiment before and after Musk’s disclosure.

Methods

We extracted tweets that were published 1 week before and after Musk's disclosure that had received >30 likes and included the terms “Aspergers” or “Aspie.” The content of each post was classified by 2 independent coders as to whether the information provided was valid, contained misinformation, or was neutral. Furthermore, we analyzed the engagement on these posts and the expressed sentiment by using the AFINN sentiment analysis tool.

Results

We extracted a total of 227 popular tweets (34 posted the week before Musk’s announcement and 193 posted the week after). We classified 210 (92.5%) of the tweets as neutral, 13 (5.7%) tweets as informative, and 4 (1.8%) as containing misinformation. Both informative and misinformative tweets were posted after Musk’s disclosure. Popular tweets posted before Musk’s disclosure were significantly more engaging (received more comments, retweets, and likes) than the tweets posted the week after. We did not find a significant difference in the sentiment expressed in the tweets posted before and after the announcement.

Conclusions

The use of social media platforms by health authorities, autism associations, and other stakeholders has the potential to increase the awareness and acceptance of knowledge about autism and Asperger syndrome. When prominent figures disclose their diagnoses, the number of posts about their particular condition tends to increase and thus promote a potential opportunity for greater outreach to the general public about that condition.

Qualitatively exploring the intersection of health and housing needs in Canadian crowdfunding campaigns

Background

Online crowdfunding platforms such as GoFundMe fundraise millions of dollars annually for campaigners. Medical crowdfunding is a very popular campaign type, with campaigners often requesting funds to cover basic health and medical care needs. Here we explore the ways that health needs intersect with housing needs in Canadian crowdfunding campaigns. In Canada, both health and housing needs may be addressed through legislative or policy intervention, are public health priorities, and are perceived as entitlements related to people’s basic human rights. We specifically develop a classification scheme of these intersections.

Methods

We extensively reviewed Canadian crowdfunding campaigns on GoFundMe, the largest charitable crowdfunding platform, using a series of keywords to form the basis of the classification scheme. Through this process we identified five categories of intersection. We extracted 100 campaigns, 20 for each category, to ascertain the scope of these categories.

Results

Five categories form the basis of the classification scheme: (1) instances of poor health creating the need to temporarily or permanently relocate to access care or treatment; (2) house modification funding requests to enhance mobility or otherwise meet some sort of health-related need; (3) campaigns posted by people with health needs who were not able to afford housing costs, which may be due to the cost of treatment or medication or the inability to work due to health status; (4) campaigns seeking funding to address dangerous or unhealthy housing that was negatively impacting health; and (5) people describing an ongoing cyclical relationship between health and housing need.

Conclusions

This analysis demonstrates that health and housing needs intersect within the crowdfunding space. The findings reinforce the need to consider health and housing needs together as opposed to using a siloed approach to addressing these pressing social issues, while the classification scheme assist with articulating the breadth of what such co-consideration must include.

Medical Crowdfunding Campaign Sharing Behaviour on Mobile Social Media

This study explores factors influencing the sharing behaviour of medical crowdfunding campaigns on mobile social media regarding retweeter and retweeted text features from the social influence perspective and verifies the moderating effect of potential supporter donations. Two scenario-based surveys of medical crowdfunding users are conducted in China. The first (524 samples) and second (510 samples) surveys emphasize scenarios without and with retweeted text, respectively. These surveys are tested by PLS-SEM and suggest that the credibility of retweeters and the strength of their relationship with supporters can positively promote potential supporters' sharing behaviour, regardless of whether retweeters provide retweeted text. Three features of retweeted text significantly influence medical crowdfunding sharing behaviour. Retweeted text can promote sharing behaviour among individuals. With retweeted text available, if potential supporters donate before sharing the campaign, then the influences of retweeter and retweeted text features can be increased.

GoFundMe isn't a Medical Plan: An Ecological Study of Crowdfunding Insulin Success (Preprint)

Background

Individuals in need of medical care turn to crowdfunding websites to engage a “crowd” or group for financial support. In the last decade, access to insulin has decreased considerably for several reasons, including the rising cost of insulin, increasing popularity of high-deductible insurance plans, and increasing insurance premiums. Many people with diabetes are forced to ration or go without insulin, and they turn to crowdfunding websites to seek financial donations to purchase insulin needed to reduce health risks and mortality, and sustain quality of life. 

Objective

This study aimed to explore crowdfunding campaign requests to purchase insulin in the United States.

Methods

In this retrospective, quantitative, and qualitative study, we coded the text of GoFundMe online crowdfunding campaigns and viral measures (shares, hearts, and comments) from February 25 to April 15, 2019. We described campaigns (N=205) and explored the factors associated with campaign success using correlations and qualitative thematic analysis.

Results

The majority of campaigns were initiated by middle-aged adults (age 26-64 years; 77/205, 37.6%), those with type 1 diabetes (94/205, 45.9%), and those needing funds owing to insurance coverage issues (125/205, 61.0%). The factors associated with campaign success included requests for ≤US $500 (P=.007) and higher viral measures (shares, P=.007; hearts, P<.001; comments, P=.002). The following 4 themes emerged from the campaign text: (1) desire for self-management and survival, (2) diabetes management untenable given insulin access, (3) aftermath of insulin unaffordability, and (4) privacy issues with crowdfunding. Campaign comments were both supportive (tangible, informational, and emotional) and unsupportive (questioned the need for the campaign and deemed crowdfunding inappropriate).

Conclusions

Despite crowdfunding websites being used to support the purchase of insulin, campaigns raised only a fraction of the money requested. Therefore, GoFundMe campaigns are not a reliable solution to obtain funds for insulin in the United States. Applying quantitative and qualitative methods is adequate to analyze online crowdfunding for costs of medications such as insulin. However, it is critical for people with diabetes to use resources other than online crowdfunding to access and obtain insulin owing to low success rates. Clinicians should routinely assess difficulty accessing or affording insulin, and federal health care policies should support lowering the cost of insulin.

Effect of Textual Features on the Success of Medical Crowdfunding: Model Development and Econometric Analysis from the Tencent Charity Platform

Background

Medical crowdfunding utilizes the internet to raise medical funds. Medical crowdfunding has developed rapidly worldwide; however, most medical crowdfunding projects fail to raise the targeted funds. Therefore, a very important research problem that has not received sufficient attention from the existing literature is identifying which factors affect the success of medical crowdfunding projects.

Objective

The aim of this study was to examine the effect of textual features of medical crowdfunding projects on their success rate using 4903 real projects from the Tencent Charity platform, a well-known medical crowdfunding platform in China. In particular, according to Aristotle’s theory of persuasion, we divided the project text of medical crowdfunding into the project title and project details, which were analyzed from two perspectives (existence and extent) to explore their respective impacts.

Methods

We established a research framework to meet our research goals. The process was divided into five main parts. We first collected data from Tencent Charity using Python programs and cleaned the datasets. Second, we selected variables and built the research model based on previous studies and the theory of persuasion. Next, the selected variables were extracted from the project text. We then performed econometric analysis using multiple regression analysis. Finally, we evaluated the results of econometric analysis to extract knowledge.

Results

In the project title, the presence of the patient’s disease (P=.04) and occupation (P=.01) had a positive impact on the success rate of fundraising, whereas the presence of age (P<.001), gender (P=.001), and negative emotions (P=.04) had a negative impact. In the project details, the presence of the patient’s occupation (P=.01), monetary evidence (P=.02), and negative emotions (P=.04) played a positive role in the fundraising success rate, whereas the presence of age (P<.001) and positive emotions (P<.001) played a negative role. Moreover, in the project details, high-frequency monetary evidence (P=.02) and negative words (P=.02), as well as a short narrative length (P=.01) were conducive to succeeding in medical crowdfunding. Younger patients were more likely to obtain a higher success rate in medical crowdfunding. For patients whose occupations were national civil servant, professional skill worker, clerk, business and service worker, solider, child, student, and public-spirited person, the success rate of fundraising decreased sequentially.

Conclusions

This study collected 4903 valid data from Tencent Charity, and identified which factors in the project text play an important role in the success rate of medical crowdfunding from the perspective of existence and extent. We found that in addition to the project details, the features of the project title also have an important impact on the success rate of fundraising. These findings provide important theoretical and managerial implications for medical crowdfunding.

Assessment of Agreement Between Human Ratings and Lexicon-Based Sentiment Ratings of Open-Ended Responses on a Behavioral Rating Scale

To date, there is a paucity of research conducting natural language processing (NLP) on the open-ended responses of behavior rating scales. Using three NLP lexicons for sentiment analysis of the open-ended responses of the Behavior Assessment System for Children-Third Edition, the researchers discovered a moderately positive correlation between the human composite rating and the sentiment score using each of the lexicons for strengths comments and a slightly positive correlation for the concerns comments made by guardians and teachers. In addition, the researchers found that as the word count increased for open-ended responses regarding the child's strengths, there was a greater positive sentiment rating. Conversely, as word count increased for open-ended responses regarding child concerns, the human raters scored comments more negatively. The authors offer a proof-of-concept to use NLP-based sentiment analysis of open-ended comments to complement other data for clinical decision making.

Medical crowdfunding in a healthcare system with universal coverage: an exploratory study

Background

In recent years, crowdfunding for medical expenses has gained popularity, especially in countries without universal health coverage. Nevertheless, universal coverage does not imply covering all medical costs for everyone. In countries with universal coverage unmet health care needs typically emerge due to financial reasons: the inability to pay the patient co-payments, and additional and experimental therapies not financed by the health insurance fund. This study aims at mapping unmet health care needs manifested in medical crowdfunding campaigns in a country with universal health coverage.

Methods

In this exploratory study we assess unmet health care needs in Germany by investigating 380 medical crowdfunding campaigns launched on Leetchi.com. We combine manual data extraction with text mining tools to identify the most common conditions, diseases and disorders which prompted individuals to launch medical crowdfunding campaigns in Germany. We also assess the type and size of health-related expenses that individuals aim to finance from donations.

Results

We find that several conditions frequently listed in crowdfunding campaigns overlap with the most disabling conditions: cancer, mental disorders, musculoskeletal disorders, and neurological disorders. Nevertheless, there is no strong association between the disease burden and the condition which prompted individuals to ask for donations. Although oral health, lipoedema, and genetic disorders and rare diseases are not listed among leading causes of disability worldwide, these conditions frequently prompted individuals to turn to crowdfunding. Unmet needs are the highest for various therapies not financed by the health insurance fund; additional, complementary, and animal-assisted therapies are high on the wish list. Numerous people sought funds to cover the cost of scientifically poorly supported or unsupported therapies. In line with the social drift hypothesis, disability and bad health status being associated with poor socioeconomic status, affected individuals frequently collected donations for their living expenses.

Conclusions

In universal healthcare systems, medical crowdfunding is a viable option to finance alternative, complementary, experimental and scientifically poorly supported therapies not financed by the health insurance fund. Further analysis of the most common diseases and disorders listed in crowdfunding campaigns might provide guidance for national health insurance funds in extending their list of funded medical interventions. The fact of numerous individuals launching crowdfunding campaigns with the same diseases and disorders signals high unmet needs for available but not yet financed treatment. One prominent example of such treatment is liposuction for patients suffering from lipoedema; these treatments were frequently listed in crowdfunding campaigns and might soon be available for patients at the expense of statutory health insurance in Germany.

Equity in access to facial transplantation

We examine ethical considerations in access to facial transplantation (FT), with implications for promoting health equity. As a form of vascularised composite allotransplantation, FT is still considered innovative with a relatively low volume of procedures performed to date by a small number of active FT programmes worldwide. However, as numbers continue to increase and institutions look to establish new FT programmes, we anticipate that attention will shift from feasibility towards ensuring the benefits of FT are equitably available to those in need. This manuscript assesses barriers to care and their ethical implications across a number of considerations, with the intent of mapping various factors relating to health equity and fair access to FT. Evidence is drawn from an evolving clinical experience as well as published scholarship addressing several dimensions of access to FT. We also explore novel concerns that have yet to be mentioned in the literature.

A Comparison of Online Medical Crowdfunding in Canada, the UK, and the US

IMPORTANCE

Despite major differences in their health care systems, medical crowdfunding is increasingly used to finance personal health care costs in Canada, the UK, and the US. However, little is known about the campaigns designed to raise monetary donations for medical expenses, the individuals who turn to crowdfunding, and their fundraising intent.

OBJECTIVE

To examine the demographic characteristics of medical crowdfunding beneficiaries, campaign characteristics, and their association with funding success in Canada, the UK, and the US.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study extracted and manually reviewed data from GoFundMe campaigns discoverable between February 2018 and March 2019. All available campaigns on each country domain's GoFundMe medical discovery webpage that benefitted a unique patient(s) were included from Canada, the UK, and the US. Data analysis was performed from March to December 2019.

EXPOSURES

Campaign and beneficiary characteristics.

MAIN OUTCOMES AND MEASURES

Log-transformed amount raised in US dollars.

RESULTS

This study examined 3396 campaigns including 1091 in Canada, 1082 in the UK, and 1223 in the US. Campaigns in the US (median [IQR], $38 204 [$31 200 to $52 123]) raised more funds than campaigns in Canada ($12 662 [$9377 to $19 251]) and the UK ($6285 [$4028 to $12 348]). In the overall cohort per campaign, Black individuals raised 11.5% less (95% CI, -19.0% to -3.2%; P = .006) than non-Black individuals, and male individuals raised 5.9% more (95% CI, 2.2% to 9.7%; P = .002) than female individuals. Female (39.4% of campaigns vs 50.8% of US population; difference, 11.3%; 95% CI, 8.6% to 14.1%; P < .001) and Black (5.3% of campaigns vs 13.4% of US population; difference, 8.1%; 95% CI, 6.8% to 9.3%; P < .001) beneficiaries were underrepresented among US campaigns. Campaigns primarily for routine treatment expenses were approximately 3 times more common in the US (77.9% [272 of 349 campaigns]) than in Canada (21.9% [55 of 251 campaigns]; difference, 56.0%; 95% CI, 49.3-62.7%; P < .001) or the UK (26.6% [127 of 478 campaigns]; difference, 51.4%; 95% CI, 45.5%-57.3%; P < .001). However, campaigns for routine care were less successful overall. Approved, inaccessible care and experimental care raised 35.7% (95% CI, 25.6% to 46.7%; P < .001) and 20.9% (95% CI, 13.3% to 29.1%; P < .001), respectively, more per campaign than routine care. Campaigns primarily for alternative treatment expenses (16.1% [174 of 1079 campaigns]) were nearly 4-fold more common for cancer (23.5% [144 of 614 campaigns]) vs noncancer (6.5% [30 of 465 campaigns]) diagnoses.

CONCLUSIONS AND RELEVANCE

Important differences were observed in the reasons individuals turn to medical crowdfunding in the 3 countries examined that suggest racial and gender disparities in fundraising success. More work is needed to understand the underpinnings of these findings and their implications on health care provision in the countries examined.

Crowdfunding Campaigns and Thyroid Surgery: Who, What, Where, and How Much?

BACKGROUND

Crowdfunding has become a unique response to the challenge of health care expenses, yet it has been rarely studied by the medical community. We looked to describe the scope of crowdfunding in thyroid surgery and analyze the factors that contribute toward a successful campaign.

METHODS

In November 2018, active campaigns were retrieved from a popular crowdfunding Web site using search terms thyroidectomy and thyroid surgery and filtered to include only campaigns that originated in the United States.

RESULTS

About 1052 thyroid surgery-related campaigns were analyzed. About 836 (79.5%) involved female patients and 43 (4.1%) pediatric patients. About 792 campaigns (75.3%) referred to thyroid cancer as a primary condition, 163 (15.5%) benign thyroid disease, and 97 (9.2%) other conditions. The average amount raised per campaign was $2514.54 (range, $0-$53,160). About 338 (32.1%) campaigns were self-posted, 317 (30.1%) posted by family, and 397 (37.7%) posted by friends. Median campaign duration was 20 mo, with a median number of 16 donors, 17 hearts, and 136 social media shares. Campaigns related to thyroid cancer raised more funds ($2729.97) than benign ($1669.84) or other ($2175.03) conditions (P < 0.001). Campaigns submitted by friends ($3524.78) received more funding than those by self ($1672.48) or family ($2147.19) (P < 0.001). Campaign duration, donor number, share number, and hearts were also significant predictors of amount raised.

CONCLUSIONS

For thyroid surgery-related crowdfunding, campaigns referring to thyroid cancer had the highest amount of funds raised. Campaigns created by friends and other factors related to increased community engagement such as social media shares were also related to increased funds.

Exploring crowdfunding campaigns for abortion services

OBJECTIVES

To examine the use of crowdfunding to pay for abortion services for individuals in the United States.

STUDY DESIGN

Cross-sectional analysis of data abstracted from publicly available campaigns for abortion services on four major crowdfunding sites.

RESULTS

Among 92 crowdfunding campaigns, the median amount requested was $610 (IQR $500-$1000), the median raised was $0 (IQR $0-$444), and 19 (21%) campaigns successfully reached their fundraising goal. Campaign success did not differ by state abortion policy, but campaigns written in third person or describing maternal/fetal diagnoses raised significantly more money.

CONCLUSIONS

Although individuals use crowdfunding to finance abortion services, the success rate is low.

"Tremendous financial burden": Crowdfunding for organ transplantation costs in Canada

Online crowdfunding platforms such as GoFundMe are used to raise funds for health-related expenses associated with medical conditions such as organ transplantation. By investigating crowdfunding in Canadian organ transplantation, this study aimed to increase understanding of the motivations and outcomes of organ transplantation crowdfunding. Canadian liver and kidney transplantation campaigns posted to GoFundMe between May 30 & 31 2018 were identified and after exclusion, 258 kidney and 171 liver campaigns were included in study. These campaigns were coded for: worthiness of the campaign recipient, requested financial and non-monetary contributions, how monetary donations would be spent, and comments on the Canadian health system, among others. Results suggest Canadian organ donors, transplant candidates, recipients, and their families and caregivers experience significant financial difficulties not addressed by the public health system. Living and medication costs, transportation and relocation expenses, and income loss were the expenses most commonly highlighted by campaigners. Liver campaigns raised nearly half their goal while kidney campaigns received 11.5% of their requested amount. Findings highlight disease burden and the use of crowdfunding as a response to the extraordinary costs associated with organ transplantation. Although crowdfunding reduces some financial burden, it does not do so equitably and raises ethical concerns.

Medical crowdfunding in China: empirics and ethics

Medical crowdfunding has become a popular choice worldwide for people with unaffordable health needs. In low-income and middle-income countries with limited social welfare arrangements and a high incidence of catastrophic health spending, the market for medical crowdfunding is booming. However, relevant research was conducted exclusively in North America and Europe; little is known about medical crowdfunding activities inother contexts. As a first step towards filling this knowledge gap, this study depicts the realities of medical crowdfunding in a middle-income country China through empirical investigation and ethical analysis. We examine 100 randomly selected medical campaigns from a major Chinese crowdfunding platform and analyse the relevance of the previously identified ethical concerns to the Chinese context. The empirical findings show that Chinese campaigns have low and uneven success rates, require legally the participation of charitable organisations and focus on financial distress and family values in appealing for donations. In addition, the ethical analysis suggests that medical crowdfunding in China shares several ethical concerns raised in developed countries such as the veracity of claims and privacy violation. More importantly, our research reveals the inadequacy of current evidence and the lack of indicators to evaluate ethical issues in practice. Additional research is needed to better understand this fundraising practice across different social and cultural contexts.

Spatially exploring the intersection of socioeconomic status and Canadian cancer-related medical crowdfunding campaigns

OBJECTIVES

Medical crowdfunding is a rapidly growing practice where individuals leverage social networks to raise money for health-related needs. This practice has allowed many to access healthcare and avoid medical debt but has also raised a number of ethical concerns. A dominant criticism of this practice is that it is likely to increase inequities in access to healthcare if persons from relatively wealthy backgrounds, media connections, tech-savvy and educational attainments are best positioned to use and succeed with crowdfunding. However, limited data has been published to support this claim. Our objective in this paper is to assess this concern using socioeconomic data and information from crowdfunding campaigns.

SETTING

To assess this concern, we present an exploratory spatial analysis of a new dataset of crowdfunding campaigns for cancer-related care by Canadian residents.

PARTICIPANTS

Four datasets were used: (1) a medical crowdfunding dataset that included cancer-related campaigns posted by Canadians, (2) 2016 Census Profile for aggregate dissemination areas, (3) aggregate dissemination area boundaries and (4) forward sortation area boundaries.

RESULTS

Our exploratory spatial analysis demonstrates that use of crowdfunding for cancer-related needs in Canada corresponds with high income, home ownership and high educational attainment. Campaigns were also commonly located near city centres.

CONCLUSIONS

These findings support concerns that those in positions of relative socioeconomic privilege disproportionately use crowdfunding to address health-related needs. This study was not able to determine whether other socioeconomic dimensions such as race, gender, ethnicity, nationality and linguistic fluency are also correlated with use of medical crowdfunding. Thus, we call for further research to explore the relationship between socioeconomic variables and medical crowdfunding campaigning to explore these other socioeconomic variables and campaigns for needs unrelated to cancer.

Media portrayal of illness-related medical crowdfunding: A content analysis of newspaper articles in the United States and Canada

BACKGROUND

Medical crowdfunding is a growing phenomenon, and newspapers are publishing on the topic. This research analyzed how illness-related crowdfunding and crowdfunding campaigns have recently been represented in newspapers that are popular in the United States and Canada.

METHODS

A sample of 336 articles about medical crowdfunding published during the two year time period from October 7, 2015 to October 6, 2017 was produced using a Factiva search of the English language newspapers with the largest Canadian and United States readership. A coding frame was developed for and applied to the sample to analyze content.

RESULTS

Articles portrayed crowdfunding campaigns positively (43.75%) and neutrally (47.92%), but rarely negatively (4.76%). Articles mostly mentioned the crowdfunding phenomenon with a neutral characterization (93.75%). Few (8.63%) articles mentioned ethical issues with the phenomenon of crowdfunding. Ailments most commonly precipitating the need for a campaign included cancer (49.11%) and rare disease (as stated by the article, 36.01%). Most articles (83.04%) note where donations and contributions can be made, and 59.23% included a hyperlink to an online crowdfunding campaign website. Some articles (26.49%) mentioned a specific monetary goal for the fundraising campaign. Of the 70 (20.83%) articles that indicated the treatment sought may be inefficacious, was unproven, was experimental or lacked regulatory approval, 56 (80.00%) noted where contributions can be made and 36 (51.43%) hyperlinked directly to an online crowdfunding campaign.

CONCLUSIONS

Crowdfunding campaigns are portrayed positively much more often than negatively, many articles promote campaigns for unproven therapies, and links directly to crowdfunding campaign webpages are present in most articles. Overall, crowdfunding is often either implicitly or explicitly endorsed.