Repairing the Digital Divide Can Increase the Service Divide: The Effects of Patient Portals on Kidney Allocation

Abstract

The severe shortage of organs combined with increasing demand for them characterize the outcomes for the kidney allocation process. Despite the efforts to improve the allocation of kidneys, notable inefficiencies and unequal access to available organs persist across patient populations. The goal of this study is to examine (i) whether the adoption of a patient-oriented information technology (IT), namely the patient portals, can mitigate inefficiencies in the allocation of these scarce resources (kidneys) in general; (ii) whether the adoption of patient portals magnify or alleviate the disparity issues around access to transplants. Using a rich dataset of all the kidney transplant records in the U.S. from 2011 to 2014, we show that the likelihood that the patient receives deceased donor transplant at a given point in time increases in the presence of patient portals. However, the varying impact of IT across sub-populations may indicate that the efforts to bridge the digital divide may benefit some groups of patients at the expense of other groups, leading to further disparities.

The Role of Formative Evaluation in Promoting Digitally-based Health Equity and Reducing Bias for Resilient Health Systems: The Case of Patient Portals

“…Amongst these are the observed adverse impacts of patient portals on health equity [62,63]. Whilst portals may benefit some user groups, they might simultaneously increase health disparities in other groups [64]. Some studies have also found potential adverse impacts on patient-provider relationships [63].…”