IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v268y2021ics0277953620307905.html
   My bibliography  Save this article

Pay to skip the line: The political economy of digital testing services for HIV and other sexually transmitted infections

Author

Listed:
  • MacKinnon, Kinnon R.
  • Mykhalovskiy, Eric
  • Worthington, Catherine
  • Gómez-Ramírez, Oralia
  • Gilbert, Mark
  • Grace, Daniel

Abstract

The value of digital healthcare has been lauded in Canada at local, provincial, and national levels. Digital medicine is purported to enhance patient access to care while promising cost savings. Using institutional ethnography, we examined the potential for publicly funded digital testing for HIV and other sexually transmitted infections (STI) in Ontario, Canada. Our analyses draw from 23 stakeholder interviews with healthcare professionals conducted between 2019 and 2020, and textual analyses of government documents and private, for-profit digital healthcare websites. We uncovered a “two-tiered” system whereby private digital STI testing services enable people with economic resources to “pay to skip the line” queuing at public clinics and proceed directly to provide samples for diagnostics at local private medical labs. In Ontario, private lab corporations compete for fee-for-service contracts with government, which in turn organises opportunities for market growth when more patient samples are collected vis-à-vis digital testing. However, we also found that some infectious disease specimens (e.g., HIV) are re-routed for analysis at government public health laboratories, who may be unable to manage the increase in testing volume associated with digital STI testing due to state budget constraints. Our findings on public-private laboratory funding disparities thus discredit the claims that digital healthcare necessarily generates cost savings, or that it enhances patients’ access to care. We conclude that divergent state funding relations together with the creeping privatisation of healthcare within this “universal” system coordinate the conditions through which private corporations capitalise from digital STI testing, compounding patient access inequities. We also stress that our findings bring forth large scale implications given the context of the global COVID-19 pandemic, the rapid diffusion of digital healthcare, together with significant novel coronavirus testing activities initiated by private industry.

Suggested Citation

  • MacKinnon, Kinnon R. & Mykhalovskiy, Eric & Worthington, Catherine & Gómez-Ramírez, Oralia & Gilbert, Mark & Grace, Daniel, 2021. "Pay to skip the line: The political economy of digital testing services for HIV and other sexually transmitted infections," Social Science & Medicine, Elsevier, vol. 268(C).
    • Handle: RePEc:eee:socmed:v:268:y:2021:i:c:s0277953620307905
    DOI: 10.1016/j.socscimed.2020.113571
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953620307905
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2020.113571?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Deborah Lupton, 2014. "Apps as Artefacts: Towards a Critical Perspective on Mobile Health and Medical Apps," Societies, MDPI, vol. 4(4), pages 1-17, October.
    2. Bambra, Clare & Smith, Katherine E. & Pearce, Jamie, 2019. "Scaling up: The politics of health and place," Social Science & Medicine, Elsevier, vol. 232(C), pages 36-42.
    3. Fox, Nick & Ward, Katie & O'Rourke, Alan, 2005. "The birth of the e-clinic. Continuity or transformation in the UK governance of pharmaceutical consumption?," Social Science & Medicine, Elsevier, vol. 61(7), pages 1474-1484, October.
    4. Loozen, Edith M.H., 2015. "Public healthcare interests require strict competition enforcement," Health Policy, Elsevier, vol. 119(7), pages 882-888.
    5. Katy M E Turner & Katharine J Looker & Jonathan Syred & Adam Zienkiewicz & Paula Baraitser, 2019. "Online testing for sexually transmitted infections: A whole systems approach to predicting value," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-14, February.
    6. Petsoulas, Christina & Allen, Pauline & Hughes, David & Vincent-Jones, Peter & Roberts, Jennifer, 2011. "The use of standard contracts in the English National Health Service: A case study analysis," Social Science & Medicine, Elsevier, vol. 73(2), pages 185-192, July.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Brydges, Ryan & Nemoy, Lori & Campbell, Doug M. & Meffe, Filomena & Moscovitch, Linda & Fella, Sabina & Chandrasekaran, Nirmala & Bishop, Catherine & Khodadoust, Nazanin & Ng, Stella L., 2021. "“We can't just have a casual conversation”: An institutional ethnography-informed study of work in labour and birth," Social Science & Medicine, Elsevier, vol. 279(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Bernard, Kate & McGowan, Victoria J & Bambra, Clare, 2024. "“Power, control, strain”: Lay perceptions of health inequalities across England's ‘North South divide’," Social Science & Medicine, Elsevier, vol. 355(C).
    2. Anna Matheson, 2020. "Health Inequality as a Large-Scale Outcome of Complex Social Systems: Lessons for Action on the Sustainable Development Goals," IJERPH, MDPI, vol. 17(8), pages 1-11, April.
    3. Marco Varkevisser & Frédérique Franken & Stéphanie Geest & Erik Schut, 2023. "Competition and collaboration in health care: reconciling the irreconcilable? Lessons from The Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(7), pages 1019-1021, September.
    4. Eleonora Fichera & Hugh Gravelle & Mario Pezzino & Matt Sutton, 2013. "Choice of contracts for quality in health care: Evidence from the British NHS," Working Papers 085cherp, Centre for Health Economics, University of York.
    5. Saukko, Paula M. & Reed, Matthew & Britten, Nicky & Hogarth, Stuart, 2010. "Negotiating the boundary between medicine and consumer culture: Online marketing of nutrigenetic tests," Social Science & Medicine, Elsevier, vol. 70(5), pages 744-753, March.
    6. Curtis, Sarah & Cunningham, Niall & Pearce, Jamie & Congdon, Peter & Cherrie, Mark & Atkinson, Sarah, 2021. "Trajectories in mental health and socio-spatial conditions in a time of economic recovery and austerity: A longitudinal study in England 2011–17," Social Science & Medicine, Elsevier, vol. 270(C).
    7. Ryan Petteway & Mahasin Mujahid & Amani Allen & Rachel Morello-Frosch, 2019. "Towards a People’s Social Epidemiology: Envisioning a More Inclusive and Equitable Future for Social Epi Research and Practice in the 21st Century," IJERPH, MDPI, vol. 16(20), pages 1-21, October.
    8. Pauline Allen & Christina Petsoulas, 2016. "Pricing in the English NHS quasi market: a national study of the allocation of financial risk through contracts," Public Money & Management, Taylor & Francis Journals, vol. 36(5), pages 341-348, July.
    9. Gomez-Vidal, Cristina & Gomez, Anu Manchikanti, 2021. "Invisible and unequal: Unincorporated community status as a structural determinant of health," Social Science & Medicine, Elsevier, vol. 285(C).
    10. Petrakaki, Dimitra & Barber, Nick & Waring, Justin, 2012. "The possibilities of technology in shaping healthcare professionals: (Re/De-)Professionalisation of pharmacists in England," Social Science & Medicine, Elsevier, vol. 75(2), pages 429-437.
    11. Shih, Patti & Prokopovich, Kathleen & Degeling, Chris & Street, Jacqueline & Carter, Stacy M., 2022. "Direct-to-consumer detection of atrial fibrillation in a smartwatch electrocardiogram: Medical overuse, medicalisation and the experience of consumers," Social Science & Medicine, Elsevier, vol. 303(C).
    12. Jennifer Boyd & Clare Bambra & Robin C. Purshouse & John Holmes, 2021. "Beyond Behaviour: How Health Inequality Theory Can Enhance Our Understanding of the ‘Alcohol-Harm Paradox’," IJERPH, MDPI, vol. 18(11), pages 1-12, June.
    13. Will, Catherine M. & Weiner, Kate, 2015. "The drugs don't sell: DIY heart health and the over-the-counter statin experience," Social Science & Medicine, Elsevier, vol. 131(C), pages 280-288.
    14. Rafi Grosglik & Dan M. Kotliar, 2024. "Commodifying the microbial self: microbiome-based personalization and the quest for symbiotic singularity," Palgrave Communications, Palgrave Macmillan, vol. 11(1), pages 1-11, December.
    15. Schmid, Andreas & Varkevisser, Marco, 2016. "Hospital merger control in Germany, the Netherlands and England: Experiences and challenges," Health Policy, Elsevier, vol. 120(1), pages 16-25.
    16. Nasima Akhter & Ross Stewart Fairbairn & Mark Pearce & Jon Warren & Adetayo Kasim & Clare Bambra, 2021. "Local Inequalities in Health Behaviours: Longitudinal Findings from the Stockton-On-Tees Cohort Study," IJERPH, MDPI, vol. 18(21), pages 1-15, October.
    17. van den Hurk, Martijn & Verhoest, Koen, 2017. "On the fast track? Using standard contracts in public–private partnerships for sports facilities: A case study," Sport Management Review, Elsevier, vol. 20(2), pages 226-239.
    18. Schut, Frederik T. & Varkevisser, Marco, 2017. "Competition policy for health care provision in the Netherlands," Health Policy, Elsevier, vol. 121(2), pages 126-133.
    19. Chandeni S. Gajadien & Peter J. G. Dohmen & Frank Eijkenaar & Frederik T. Schut & Erik M. Raaij & Richard Heijink, 2023. "Financial risk allocation and provider incentives in hospital–insurer contracts in The Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(1), pages 125-138, February.
    20. Peter Congdon, 2020. "Geographical Aspects of Recent Trends in Drug-Related Deaths, with a Focus on Intra-National Contextual Variation," IJERPH, MDPI, vol. 17(21), pages 1-18, November.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:268:y:2021:i:c:s0277953620307905. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.