Elsevier

Social Science & Medicine

Volume 75, Issue 10, November 2012, Pages 1828-1835
Social Science & Medicine

How does searching for health information on the Internet affect individuals' demand for health care services?

https://doi.org/10.1016/j.socscimed.2012.07.022Get rights and content

Abstract

The emergence of the Internet made health information, which previously was almost exclusively available to health professionals, accessible to the general public. Access to health information on the Internet is likely to affect individuals' health care related decisions. The aim of this analysis is to determine how health information that people obtain from the Internet affects their demand for health care. I use a novel data set, the U.S. Health Information National Trends Survey (2003–07), to answer this question. The causal variable of interest is a binary variable that indicates whether or not an individual has recently searched for health information on the Internet. Health care utilization is measured by an individual's number of visits to a health professional in the past 12 months. An individual's decision to use the Internet to search for health information is likely to be correlated to other variables that can also affect his/her demand for health care. To separate the effect of Internet health information from other confounding variables, I control for a number of individual characteristics and use the instrumental variable estimation method. As an instrument for Internet health information, I use U.S. state telecommunication regulations that are shown to affect the supply of Internet services. I find that searching for health information on the Internet has a positive, relatively large, and statistically significant effect on an individual's demand for health care. This effect is larger for the individuals who search for health information online more frequently and people who have health care coverage. Among cancer patients, the effect of Internet health information seeking on health professional visits varies by how long ago they were diagnosed with cancer. Thus, the Internet is found to be a complement to formal health care rather than a substitute for health professional services.

Highlights

► This study investigates how health information that people obtain from the Internet affects their demand for health care. ► A novel data set – the U.S. Health Information National Trends Survey – is used in the analysis. ► I control for a number of confounding variables and use the instrumental variable estimation method. ► Searching for health information online is found to have a positive effect on an individual's health care utilization. ► This effect varies across individuals.

Introduction

This research is motivated by the observation that a large and increasing proportion of the population in developed countries use the Internet as a health information source. An estimated 27.5 percent of the U.S. adult population looked online for information about a health or medical issue in 2000 (Rice, 2006). This figure increased to 40 percent in 2002 and to 61 percent in 2008 (Fox & Jones, 2009; Rice, 2006). It is likely that health information that people obtain from the Internet influences their health related decisions, including their demand for health care services. Indeed, most of the individuals who look for health information online report that this information had a major or minor impact on their own health care or the way they cared for someone else (Fox & Jones, 2009; Rice, 2006). Additionally, some of the health information seekers say that the information obtained from the Internet led them to ask a doctor new questions or to get a second opinion from another doctor or affected their decision about whether to see a doctor or not (Rice, 2006).

There is no consensus in the literature on whether Internet health information is a substitute for or complement to health care. For example, the medical sociology literature has two opposing hypotheses related to this topic (Lee, 2008). The first hypothesis is that by diffusing health knowledge, which was previously available only to health professionals, the Internet may reduce people's dependence on health professionals as a source of health information and, consequently, lower the frequency of their visits to health professionals. Patients may elect to use online health information to diagnose and treat themselves rather than visit a doctor to reduce monetary and time costs. The second hypothesis states that, despite people's access to health knowledge, the knowledge gap between the general public and health professionals remains, since new information constantly emerges and is first available to health professionals. Furthermore, health and medical information involves uncertainty and error; therefore, people rely on health professionals for the interpretation of Internet health information. Online health information may also make individuals more concerned about their health and well-being. As a result, increasing access to health information on the Internet may, in fact, increase the frequency of people's visits to health professionals.

Existing empirical research investigating the effect of Internet health information on the demand for health care reaches inconclusive and inconsistent conclusions. For example, Khechine, Pascot, and Prémont (2007) find a positive association between individuals' intensity of Internet use for health purposes and their utilization of health care services. These results are, however, based on a small and non-random sample of individuals who are Internet users and have a long-term medical condition. The authors do not control for unobserved individual characteristics that are likely to be correlated with both health information seeking intensity and health care utilization. Therefore, the positive correlation between Internet use for health purposes and health care utilization cannot be interpreted as causal. There are two studies that do address the endogeneity of Internet health information seeking. The first study uses panel data to estimate a model that controls for an individual's health care utilization in the base period and finds that the intensity of Internet health information exposure has a positive effect on two health care utilization measures, contacting a physician for information and visiting a physician for treatment (Lee, 2008). To the contrary, the second study finds a small, negative, and insignificant effect of computerized health information use on an individual's number of doctor visits, using instrumental variable and fixed effect methods (Wagner & Jimison, 2003). Additionally, it is investigated whether computerized health information affects the probability of visiting a doctor and a positive, but statistically insignificant effect is found (Wagner & Jimison, 2003). Thus, this paper contributes to the literature by providing additional evidence on the effect of Internet health information seeking on health care utilization.

Section snippets

Methodology

In this analysis, an individual's demand for health care HCi is modeled as a function of a binary variable indicating whether or not an individual is an Internet health information seeker eHii, observed demographic characteristics Xi (age, sex, education, race, and marital status), and unobserved variables ci:HCi=β0+β1eHii+Xiβ2+ci.

The variable of interest in this analysis is eHii. A positive coefficient on eHii would suggest that Internet health information is a complement to health care. A

Data

For the empirical analysis, I use the data from the U.S. Health Information National Trends Survey (HINTS) (National Cancer Institute, 2006–2009). Given that this data is de-identified and publicly available, no ethical approval was needed for this study. The HINTS is a repeated cross-sectional survey of the U.S. civilian non-institutionalized adult population. The National Cancer Institute (NCI) manages and funds the survey. The NCI is part of the National Institutes of Health, a medical

Results

The first stage results, presented in Table 2, show that the instrument is indeed strongly correlated to the variable of interest. The probability of being an Internet health information seeker is 4 percentage points higher for individuals living in states with more favorable right-of-way policies compared to individuals living in states with less favorable right-of-way policies, holding other factors fixed. The estimated coefficient on the instrument is statistically significant at the one

Discussion and conclusions

The results of the empirical analysis presented in the previous section suggest that Internet health information has a positive effect on the demand for health care. Other factors being equal, e-health information seekers demand more health care than non-seekers. One possible explanation for this finding is that the information that e-health information seekers obtain from the Internet makes them more concerned about their health compared to otherwise similar non-seekers. Most of the

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I am grateful to Denise Doiron, Denzil Fiebig, Shiko Maruyama, Mark Rosenzweig, Kevin Lang, Hong Il Yoo, Adeline Tubb, two anonymous reviewers, and the participants of the 7th Summer Workshop in Health Economics, the 1st Annual Workshop on Health IT and Economics, and 8th World Congress on Health Economics for their helpful comments and advice. All opinions and any mistakes are my own.

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