How does searching for health information on the Internet affect individuals' demand for health care 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:
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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2022, Social Science and MedicineCitation Excerpt :By contrast, the mothers are cautious about medical issues and suggest that emergency situations, like scalding, deserve the attention of doctors. As in the existing literature (Sillence et al., 2007; Suziedelyte, 2012), the mothers still value expert knowledge, especially for medical matters, because of their expectations around the functionality of institutionalized medicine (Pilnick and Dingwall, 2011; Lindström and Karlsson, 2016). In contrast, for alternative information as a type of experiential knowledge (ranging from use of the internet to consulting their social networks), the mothers were concerned about credibility and validity (Blume, 2017).
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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.