Equity and Efficiency in Technology Adoption: Evidence from Digital Health

Digital technologies are bringing vast improvements to modern society but also carry the risk of perpetuating disparities if adopted at lower rates by underserved communities. We investigate the efficiency and equity aspects of technological advancement in digital health by studying an intervention of “remote patient monitoring” that enabled patients to transmit real-time clinical data for timely treatment. The program was deployed at the Academic Medical Center UC San Diego Health among a diverse population of patients and targeted hypertension management to reduce the risk of cardiovascular disease. From an efficiency standpoint, we find significant and persistent reductions in cardiovascular risk, which are notable across all subgroups of gender, age, race/ethnicity, and geographic affluence. Evidence suggests both reduced frictions in the provision of care and improved health behaviors as mechanisms. The program also led to significant reductions in healthcare utilization costs from improved hypertension control. From an equity standpoint, however, we find that the longer-run health gains from the program fell short among underserved patient subpopulations, inducing inequities in the reductions in cardiovascular risk. The new technology was systematically adopted at lower rates by Black/Hispanic patients and by patients from disadvantaged geographic communities, who were less likely to either take up or adhere to the program. Overall, our analysis highlights the simultaneous promise and hazards of digital health technologies. We further provide evidence that primary care physicians and the nature of their relationship with patients can have a promising role in promoting greater and more equitable adoption of digital health.