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 characterizes 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.