Does Telehealth Reduce Rural-Urban Care Access Disparities? Evidence from Covid-19 Telehealth Expansion

Using hospital claims data, we study the effect of telehealth expansion on the disparities between care access in rural and urban areas during Covid-19. We use urban areas as the control group and compare the changes in patients' access to care before and after the telehealth expansion. We find that the rural-urban disparities in overall access to care (i.e., the total number of visits) remain unchanged after the policy. We further distinguish in-person from telehealth visits and find enlarged disparities in patients' visiting modalities. In particular, urban patients substitute in-person visits with telehealth visits, yet rural patients have a much lower adoption rate of telehealth services and continue with in-person visits. Finally, we perform visit-level analyses and identify patients' social determinants and physicians' characteristics associated with telehealth adoptions

Dynamic behavior of a parasite–host model with general incidence

AbstractIn this paper, we consider the global dynamics of a microparasite model with more general incidences. For the model with the bilinear incidence, Ebert et al. [D. Ebert, M. Lipsitch, K.L. Mangin, The effect of parasites on host population density and extinction: Experimental epidemiology with Daphnia and six microparasites, American Naturalist 156 (2000) 459–477] observed that parasites can reduce host density, but the extinction of both host population and parasite population occurs only under stochastic perturbations. Hwang and Kuang [T.W. Hwang, Y. Kuang, Deterministic extinction effect of parasites on host populations, J. Math. Biol. 46 (2003) 17–30] studied the model with the standard incidence and found that the host population may be extinct in the absence of random disturbance. We consider more general incidences that characterize transitions from the bilinear incidence to the standard incidence to simulate behavior changes of populations from random mobility in a fixed area to the mobility with a fixed population density. Using the techniques of Xiao and Ruan [D. Xiao, S. Ruan, Global dynamics of a ratio-dependent predator–prey system, J. Math. Biol. 43 (2001) 268–290], it is shown that parasites can drive the host to extinction only by the standard incidence. The complete classifications of dynamical behaviors of the model are obtained by a qualitative analysis

Does Telemedicine Affect Physician Decisions? Evidence from Antibiotic Prescriptions

Telemedicine has long been of interest to the U.S. general public. Yet, despite the advent of high-speed internet and mobile device technology, telemedicine did not reach its full potential until the COVID-19 pandemic spurred its unparalleled adoption. This sudden shift in the setting of healthcare delivery raises questions regarding possible changes in clinical decision-making. Using a unique set of patient-provider encounter data from the U.S. in 2020 and 2021, we examine the effect of telemedicine on antibiotic prescription errors for urinary tract infections. After accounting for potential endogeneity issues using provider fixed effects and an instrumental variable approach, we find a significantly lower likelihood of prescription errors with telemedicine relative to in-person encounters. We also find heterogeneous effects by a provider's patient volume and the patient-provider relationship