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It has become a popular idea in the media and online that a virtual cornucopia of economic, health, and social benefits are there for the taking if people begin to engage with the rampant e-health and e-medicine juggernauts that are being released to the public on a daily basis. Anyone with the will and access to a broadband connection can interface with applications such as patient and/or provider-centric electronic records and health information exchanges; participate in tele-health and other online consultations; and search for information, treatments and practitioners. Users can also plug in (or wirelessly connect) to the network to upload a plethora of vital statistics collected by the second/minute/hour/day or whatever; receive automated diagnoses, and — if the equipment is so capable — treatments dispensed with mechanical precision and control. But are the possible benefits as large as anticipated in the hype?
Hype or hyper-tension?
As some of the much-vaunted applications — such as Fitbit and other fitness-tracking apps — have been around now for quite a while, we would expect to see the monetary savings start to stack up for insurers and health benefits accruing for consumers. After all, it is not as though consumers have been slow to adopt. Insurers sufficiently persuaded by the benefits have either subsidized their supply or rewarded clients who download fitness apps and upload their daily data, while employers seeking to fulfill their health and safety obligations have proved very willing sponsors.
Surveys report that 30 percent of US consumers own a fitness band, and 20 percent of New Zealanders reportedly own fitness trackers. In the case of New Zealand, this is an impressive uptake rate for an application that has been around for about as long as the country’s infamous government-subsidized Ultrafast Broadband network, which now boasts an uptake of 16 percent. Furthermore, Fitbit sites on various social media platforms report strong followings.
In this context, the conclusions of a recent paper in the American Journal of Medicine by researchers at the University of Florida make for very interesting reading. The authors undertook a comprehensive review of 550 empirical studies in order to determine whether there was evidence of the benefit of wearable health devices in chronic disease outcomes (notably, cardiovascular disease and diabetes) in adults. After all, this is where one would expect the largest cost savings to accrue.
Fitbits are everywhere but in the health status improvement data
Somewhat surprisingly, given all the hype, the authors found “there was little indication that wearable devices provide a benefit for health outcomes.” Of the six studies meeting the strict criteria required to assess causal relationships, “only one study showed a significant reduction in weight loss among participants who used wearable devices. No significant reduction was discovered in cholesterol or blood pressure.” They concluded that “wearable devices play an active role as a facilitator in motivating and accelerating physical activity but current data do not suggest other consistent health benefits.”
To paraphrase Robert Solow, this study might lead one to conclude that we are perhaps observing emerging evidence of an e-health productivity paradox: that is, we see Fitbits everywhere but in the health status improvement data. This potentially has significant policy implications, as the sums invested in subsidizing them may have had more effect if applied somewhere else in the health sector. It also draws into question the accuracy of the high expectations of contributions from e-health applications used to bolster policies for subsidizing high-speed internet connections (both mobile and fixed-line).
On the other hand, the results may not be all that surprising. Analysis in other sectors, such as manufacturing and retail, of the effect of increasing computerization — which in its early days led Solow to make his original observation — has shown that benefits frequently take a long time to emerge, and that they almost always require significant investments in complementary assets and processes in order to realize the expected potential. These investments were frequently in the institutional processes in which computerized applications were introduced. Importantly, when investments in human capital and reforming processes were made alongside the introduction of the computerized device, the gains tended to be higher.
The University of Florida paper hints at this being an issue for Fitbits and other wearables as well. The devices facilitate motivation, but other investments may be needed to deliver the anticipated health benefits. A general finding in health care is that many longer-term interventions are more successful when combined with ongoing personal engagement between a specific health care professional and the patient, in large part because the health professional can continually fine-tune elements of the intervention to suit highly variable needs of individuals. A Fitbit alone, in isolation from integration into a wider, customized treatment plan, may indeed be of little value, but when combined with those other investments, gains may become evident.
Spending more to save more
If that is the case, then two other major policy implications emerge. First, e-health applications such as Fitbits may not actually save any money at all. Rather, they may lead to even higher levels of expenditure in complementary investments to obtain the benefits. Second, if personal interactions by health care providers are one of the costly complements, then the rise of computerization and automation in the health sector may not be as big a threat to the health care workforce as some scenarios have predicted. The ways health care professionals and individuals interact may change with new technologies, but the personal relationships will likely still be important.
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