DO HEALTH INFORMATION TECHNOLOGIES HELP OR HURT VULNERABLE POPULATIONS ?
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Graduate group
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Economics
Subject
maternal health
mental health
privacy
telehealth
vulnerable populations
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Abstract
Given the proliferation of health information technologies (HIT) designed for professional use only (such as Electronic Medical Records (EMR)), as well as technologies connecting healthcare pro- fessionals to patients (e.g., telehealth); this dissertation examines the effect of HIT on vulnerable populations. Despite documented economic benefits of certain HIT systems incentivized for adoption by policy makers, it is unclear whether adoption of technologies targeting vulnerable populations, such as the elderly and mothers, will generate similar benefits. On one hand, these technologies have the potential to reduce health expenditures and improve access. However, HIT for long-term care patients, such as the elderly, have not been economically incentivized and thus understudied compared to other care settings (e.g., hospitals). Long-term care considerably differs from acute care in terms of patient composition, care professional composition and the processes involved in care provision warranting special attention. Similarly, the effect or technology adoption by another vulnerable group, mothers, is not straightforward because the mothers who are most vulnerable to adverse health events, i.e. who could benefit from HIT the most, often also suffer from inadequate access to health care and from the digital divide phenomenon. Furthermore, the care process for a large contributor of these adverse health outcomes for mothers, i.e. mental health care, is subject to additional concerns arising from privacy. This dissertation uses large-scale empirical analyses to study potential economic benefits of HIT use by vulnerable groups, the socioeconomic disparities in utilization, and privacy concerns that can reduce HIT utilization. The first essay analyzes the economic effect of EMR adoption by nursing homes, which mainly serve the aging population with multiple chronic diseases. In addition to finding a reduction in the out-of-home (hospitalization) expenditures of residents staying in adopter nursing homes, we also identify additional economic benefits through simultaneous EMR use by nursing homes and hospitals. Our findings emphasize the importance of accounting for the interconnected nature of care delivery when considering HIT adoption. The second essay investigates offline (physical) privacy concerns in relation to mental health care provision through telehealth. We find evidence for increased psychotherapy utilization in the post- partum (after birth) period due to rapid expansion of telehealth services. However, offline privacy concerns affect mental health delivery differently depending on the dominating privacy concern: Alleviating concerns about societal stigma due to reduced observability, telehealth may help overcome "privacy in the community" concerns, but may give rise to "privacy at home" concerns for individ- uals in crowded households. Our insights encourage policy makers and health system managers to take into account the patient pool they serve when making decisions regarding reimbursement of telehealth services or provider capacity allocation to different channels. Finally, the last essay investigates the potential of telehealth to alleviate the maternal health crisis. Telehealth can substitute for postpartum in-person visits to some extent, and contrary to concerns about racial disparities in technology use, we do not find any difference in telehealth use by different groups of mothers. Overall, this dissertation demonstrates potential benefits of HIT to alleviate the disadvantages faced by vulnerable groups in care delivery, and privacy concerns associated with HIT use.