Access AND efficiency: the effects of online triaging on health and healthcare

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This paper studies the access & efficiency effects of implementing online triage for healthcare services. In many contexts, healthcare services are offered at low or no cost to individuals, generating an excess of demand that needs to be rationed via capacity constraints and/or ordeals. We study the introduction of an online platform to receive and prioritize patients’ requests (Triage) on primary care services in Chile; online triaging removes the need to attend in person to make a request and prioritizes individuals with worse health status to receive services. We exploit the staggered rollout of the program to estimate its effects on clinic choice, health outcomes, and private opt-out use; we find that this form of targeting increases enrollment in clinics with Triage by 1-2%, mostly on lower-middle income groups; at the same time, Triage also decreases avoidable hospitalizations by 3-10%, suggesting that online Triage can improve both access & efficiency in primary care. We further show that Triage induces an increase in demand for private healthcare driven by the upper income groups, highlighting the equity-efficiency tradeoff of prioritization.