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Broadband Internet access and health outcomes: Patient and provider responses in Medicare

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  • Van Parys, Jessica
  • Brown, Zach Y.

Abstract

High-speed internet has increased the amount of information available in health care markets. Online information may improve health outcomes if it reduces information frictions and helps patients choose higher quality providers or causes providers to improve quality. We examine how health outcomes for common procedures in Medicare changed after broadband internet rolled out across ZIP Codes from 1999 to 2008. Estimates imply that broadband expansion improved health outcomes by 5%. Broadband access primarily helped patients choose higher-quality providers; we also find some evidence that broadband improved provider quality. We use a structural model to decompose the improvements in patient outcomes over time. Counterfactual simulations imply that broadband roll-out was responsible for 16% of the improvement in outcomes by the end of the period.

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  • Van Parys, Jessica & Brown, Zach Y., 2024. "Broadband Internet access and health outcomes: Patient and provider responses in Medicare," International Journal of Industrial Organization, Elsevier, vol. 95(C).
  • Handle: RePEc:eee:indorg:v:95:y:2024:i:c:s0167718724000274
    DOI: 10.1016/j.ijindorg.2024.103072
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    as
    1. repec:mpr:mprres:7375 is not listed on IDEAS
    2. Jason Abaluck & Jonathan Gruber, 2011. "Choice Inconsistencies among the Elderly: Evidence from Plan Choice in the Medicare Part D Program," American Economic Review, American Economic Association, vol. 101(4), pages 1180-1210, June.
    3. Manudeep Bhuller & Andreas R. Kostol & Trond C. Vigtel, 2019. "How Broadband Internet Affects Labor Market Matching," CESifo Working Paper Series 8022, CESifo.
    4. Benjamin R. Handel & Jonathan T. Kolstad, 2015. "Health Insurance for "Humans": Information Frictions, Plan Choice, and Consumer Welfare," American Economic Review, American Economic Association, vol. 105(8), pages 2449-2500, August.
    5. David C. Chan, 2021. "Influence and Information in Team Decisions: Evidence from Medical Residency," American Economic Journal: Economic Policy, American Economic Association, vol. 13(1), pages 106-137, February.
    6. Gabriel Ahlfeldt & Pantelis Koutroumpis & Tommaso Valletti, 2017. "Speed 2.0: Evaluating Access to Universal Digital Highways," Journal of the European Economic Association, European Economic Association, vol. 15(3), pages 586-625.
    7. Bundorf, M. Kate & Chun, Natalie & Goda, Gopi Shah & Kessler, Daniel P., 2009. "Do markets respond to quality information? The case of fertility clinics," Journal of Health Economics, Elsevier, vol. 28(3), pages 718-727, May.
    8. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    9. Kolko, Jed, 2012. "Broadband and local growth," Journal of Urban Economics, Elsevier, vol. 71(1), pages 100-113.
    10. Jeffrey R. Kling & Sendhil Mullainathan & Eldar Shafir & Lee C. Vermeulen & Marian V. Wrobel, 2012. "Comparison Friction: Experimental Evidence from Medicare Drug Plans," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(1), pages 199-235.
    11. Arthur Grimes & Cleo Ren & Philip Stevens, 2012. "The need for speed: impacts of internet connectivity on firm productivity," Journal of Productivity Analysis, Springer, vol. 37(2), pages 187-201, April.
    12. Jason Abaluck & Jonathan Gruber, 2011. "Heterogeneity in Choice Inconsistencies among the Elderly: Evidence from Prescription Drug Plan Choice," American Economic Review, American Economic Association, vol. 101(3), pages 377-381, May.
    13. Chou, Shin-Yi & Deily, Mary E. & Li, Suhui & Lu, Yi, 2014. "Competition and the impact of online hospital report cards," Journal of Health Economics, Elsevier, vol. 34(C), pages 42-58.
    14. Amitabh Chandra & Amy Finkelstein & Adam Sacarny & Chad Syverson, 2016. "Health Care Exceptionalism? Performance and Allocation in the US Health Care Sector," American Economic Review, American Economic Association, vol. 106(8), pages 2110-2144, August.
    15. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2011. "Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms," Economic Journal, Royal Economic Society, vol. 121(554), pages 228-260, August.
    16. Billari, Francesco C. & Giuntella, Osea & Stella, Luca, 2018. "Broadband internet, digital temptations, and sleep," Journal of Economic Behavior & Organization, Elsevier, vol. 153(C), pages 58-76.
    17. Michael DiNardi & Melanie Guldi & David Simon, 2019. "Body weight and Internet access: evidence from the rollout of broadband providers," Journal of Population Economics, Springer;European Society for Population Economics, vol. 32(3), pages 877-913, July.
    18. Jessica Van Parys, 2016. "Variation in Physician Practice Styles within and across Emergency Departments," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-19, August.
    19. Daniel P. Kessler & Mark B. McClellan, 2000. "Is Hospital Competition Socially Wasteful?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(2), pages 577-615.
    20. Lisa J. Dettling & Sarena Goodman & Jonathan Smith, 2018. "Every Little Bit Counts: The Impact of High-Speed Internet on the Transition to College," The Review of Economics and Statistics, MIT Press, vol. 100(2), pages 260-273, May.
    21. Goodman-Bacon, Andrew, 2021. "Difference-in-differences with variation in treatment timing," Journal of Econometrics, Elsevier, vol. 225(2), pages 254-277.
    22. Ethan M. J. Lieber, 2017. "Does It Pay to Know Prices in Health Care?," American Economic Journal: Economic Policy, American Economic Association, vol. 9(1), pages 154-179, February.
    23. Joseph J. Doyle Jr. & John A. Graves & Jonathan Gruber & Samuel A. Kleiner, 2015. "Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns," Journal of Political Economy, University of Chicago Press, vol. 123(1), pages 170-214.
    24. Jeffrey R. Brown & Austan Goolsbee, 2002. "Does the Internet Make Markets More Competitive? Evidence from the Life Insurance Industry," Journal of Political Economy, University of Chicago Press, vol. 110(3), pages 481-507, June.
    25. Jonathan T. Kolstad, 2013. "Information and Quality When Motivation Is Intrinsic: Evidence from Surgeon Report Cards," American Economic Review, American Economic Association, vol. 103(7), pages 2875-2910, December.
    26. Atif, Syed Muhammad & Endres, James & Macdonald, James, 2012. "Broadband Infrastructure and Economic Growth: A Panel Data Analysis of OECD Countries," MPRA Paper 42177, University Library of Munich, Germany.
    27. Jonathan T. Kolstad, 2013. "Information and Quality when Motivation is Intrinsic: Evidence from Surgeon Report Cards," NBER Working Papers 18804, National Bureau of Economic Research, Inc.
    28. Gabor Molnar & Scott J. Savage, 2017. "Market Structure and Broadband Internet Quality," Journal of Industrial Economics, Wiley Blackwell, vol. 65(1), pages 73-104, March.
    29. Amit Gandhi & Zhentong Lu & Xiaoxia Shi, 2023. "Estimating demand for differentiated products with zeroes in market share data," Quantitative Economics, Econometric Society, vol. 14(2), pages 381-418, May.
    30. Steven T. Berry, 1994. "Estimating Discrete-Choice Models of Product Differentiation," RAND Journal of Economics, The RAND Corporation, vol. 25(2), pages 242-262, Summer.
    31. Amitabh Chandra & Douglas O Staiger, 2020. "Identifying Sources of Inefficiency in Healthcare [“The Determinants of Productivity in Medical Testing: Intensity and Allocation of Care,”]," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 135(2), pages 785-843.
    32. Nina Czernich & Oliver Falck & Tobias Kretschmer & Ludger Woessmann, 2011. "Broadband Infrastructure and Economic Growth," Economic Journal, Royal Economic Society, vol. 121(552), pages 505-532, May.
    33. Ginger Zhe Jin & Phillip Leslie, 2003. "The Effect of Information on Product Quality: Evidence from Restaurant Hygiene Grade Cards," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 118(2), pages 409-451.
    34. Dranove, David & Sfekas, Andrew, 2008. "Start spreading the news: A structural estimate of the effects of New York hospital report cards," Journal of Health Economics, Elsevier, vol. 27(5), pages 1201-1207, September.
    35. Fiona Scott Morton & Florian Zettelmeyer & Jorge Silva‐Risso, 2001. "Internet Car Retailing," Journal of Industrial Economics, Wiley Blackwell, vol. 49(4), pages 501-519, December.
    36. Janet Currie & W. Bentley MacLeod, 2017. "Diagnosing Expertise: Human Capital, Decision Making, and Performance among Physicians," Journal of Labor Economics, University of Chicago Press, vol. 35(1), pages 1-43.
    37. Sofia Amaral-Garcia & Mattia Nardotto & Carol Propper & Tommaso Valletti, 2022. "Mums Go Online: Is the Internet Changing the Demand for Health Care?," The Review of Economics and Statistics, MIT Press, vol. 104(6), pages 1157-1173, November.
    38. Currie, Janet & MacLeod, W. Bentley & Van Parys, Jessica, 2016. "Provider practice style and patient health outcomes: The case of heart attacks," Journal of Health Economics, Elsevier, vol. 47(C), pages 64-80.
    39. Berry, Steven & Levinsohn, James & Pakes, Ariel, 1995. "Automobile Prices in Market Equilibrium," Econometrica, Econometric Society, vol. 63(4), pages 841-890, July.
    40. Martin Gaynor & Carol Propper & Stephan Seiler, 2016. "Free to Choose? Reform, Choice, and Consideration Sets in the English National Health Service," American Economic Review, American Economic Association, vol. 106(11), pages 3521-3557, November.
    41. Fiona Scott Morton & Florian Zettelmeyer & Jorge Silva-Risso, 2001. "Internet Car Retailing," NBER Chapters, in: E-commerce, pages 501-519, National Bureau of Economic Research, Inc.
    42. repec:bla:jindec:v:49:y:2001:i:4:p:501-19 is not listed on IDEAS
    43. Zach Y. Brown, 2019. "Equilibrium Effects of Health Care Price Information," The Review of Economics and Statistics, MIT Press, vol. 101(4), pages 699-712, October.
    44. Jenny Aker, 2008. "Does Digital Divide or Provide? The Impact of Cell Phones on Grain Markets in Niger," Working Papers 154, Center for Global Development.
    45. Leemore Dafny & David Dranove, 2008. "Do report cards tell consumers anything they don't already know? The case of Medicare HMOs," RAND Journal of Economics, RAND Corporation, vol. 39(3), pages 790-821, September.
    46. Samara R. Gunter, 2019. "Your biggest refund, guaranteed? Internet access, tax filing method, and reported tax liability," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 26(3), pages 536-570, June.
    47. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    48. Jonas Hjort & Jonas Poulsen, 2019. "The Arrival of Fast Internet and Employment in Africa," American Economic Review, American Economic Association, vol. 109(3), pages 1032-1079, March.
    49. Kolko, Jed, 2010. "How broadband changes online and offline behaviors," Information Economics and Policy, Elsevier, vol. 22(2), pages 144-152, May.
    50. Joseph Doyle & John Graves & Jonathan Gruber, 2019. "Evaluating Measures of Hospital Quality: Evidence from Ambulance Referral Patterns," The Review of Economics and Statistics, MIT Press, vol. 101(5), pages 841-852, December.
    51. Zack Cooper & Joseph J. Doyle Jr. & John A. Graves & Jonathan Gruber, 2022. "Do Higher-Priced Hospitals Deliver Higher-Quality Care?," NBER Working Papers 29809, National Bureau of Economic Research, Inc.
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    More about this item

    Keywords

    Broadband; Hospital competition; Quality competition; Information frictions;
    All these keywords.

    JEL classification:

    • L15 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Information and Product Quality
    • L86 - Industrial Organization - - Industry Studies: Services - - - Information and Internet Services; Computer Software
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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