Technology, Innovation & Healthcare Markets in Low- and Middle-Income Countries: A Study of Telemedicine in India

While Covid propelled the growth of telemedicine in low- and middle-income countries (LMICs), little is understood about the effectiveness of telemedicine or how it can be leveraged to plug the provider shortage and increase access to care in these settings. This dissertation aims to further the understanding of telemedicine by studying different paradigms of telemedicine in India. In the first study, I explore the motivations and barriers to health practitioner engagement on a volunteer telemedicine network during the Covid pandemic. Through in-depth qualitative interviews conducted with practitioners, I find that providers are highly intrinsically motivated to volunteer to address the healthcare needs of the underserved, and value non-pecuniary rewards towards maintaining regular voluntary engagement online. In the second study, I investigate the impact of a large-scale telemedicine network that operated several models of telemedicine during Covid on Covid health outcomes. When differentiated by timing of adoption, I find that late adopters of the intervention demonstrate effects as large as 23 percentage points on Covid positive case rates. The model that triaged already diagnosed Covid patients through the available health infrastructure demonstrated the biggest impact with an effect of 23 percentage points on the Covid positive rate and of 6 percentage points on the fatality rate. In the third study, I evaluate two interventions – a mandate and a platform update – designed to sustain telemedicine adoption. While the mandate has an immediate impact on the number of teleconsults conducted, this effect does not sustain over time. The platform update, which solvers for ease of use, results in a decrease of 0.6 teleconsults per doctor in the week following the rollout. However, this trend reverses over time, resulting in an increase of 0.03 teleconsults per doctor per week in the following weeks. The findings underscore the potential of telemedicine to address inequities in medical provider availability and access to healthcare in LMICs. However, mechanisms to sustain provider engagement outside of times of crisis are important. Non-pecuniary incentives and solving for ease of use of platforms are potential instruments to sustain provider engagement with telemedicine.