Three essays on technology and healthcare
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Date
2020
Authors
Rodriguez Llorian, Elisabet
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Abstract
Advances in medical technology have changed the standards of models of care, while also constituting a driving force in raising costs. This thesis addresses the various impacts of technology on healthcare through three chapters.
The first chapter investigates to what extent medical technology drives healthcare expenditure for a panel of Canadian provinces and another of OECD countries. A careful examination of existing technology proxies is conducted, and three new proxies are added to the literature. A novel dynamic common correlated effect approach from the emerging field of panel time series is employed to explore the relationship between healthcare expenditure and technology. As expected, the variables are tied together by a long-run relationship, but the speed of adjustment varies depending on the technology proxy used and the level of aggregation.
The second and third chapters study the effect of two forms of health information technology on a variety of healthcare and health outcomes. Specifically, two programs are investigated: telemedicine and electronic medical records (EMR). Both programs take place in the Canadian province of Manitoba. The linkable administrative data housed at the Manitoba Centre for Health Policy was used to create cohorts of users and non-users for each of the programs.
The second chapter uses a propensity-weighted regression model to measure the impact of telemedicine on four indicators of healthcare use. Results point to increased use of healthcare services for telemedicine users. But for those patients who showed higher intensity of use, telemedicine seems to be a substitute for regular care, and not an addition to it.
Finally, the third chapter explores the association, at a primary care level, between use of electronic medical records and quality of care measures. A set of indicators covering preventive care, chronic disease management, and healthcare utilization are investigated through a difference-in-differences approach with patient and time fixed effects, and an estimation strategy that uses the variation in timing of adoption. Results show that patients with diabetes in primary care practices using EMR’s show improved management indicators, while no evidence of changes in preventive care or hospitalizations for a set of ambulatory care sensitive conditions is found.
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Keywords
Technology, Healthcare, Telemedicine, Healthcare expenditure, Electronic medical records
Citation
APA