Building a digital republic to reduce health disparities and improve population health in the United States

Abstract

Income, schooling, and healthcare are key ingredients for health, but most government programs that are designed to provide these social benefits are difficult to access, target those least in need, and carry enormous administrative costs. Benefits such as Temporary Assistance for Needy Families or Medicaid are difficult to enroll in, so only those who have the cognitive capacity to navigate the application process receive those benefits. The bureaucracies of welfare programs also increase the cost of administering the program. Redundancies in welfare programs also mean that there are redundant bureaucracies. In this commentary, we discuss a novel method for improving health while also improving privacy, reducing fraud, and improving data system compatibility. Specifically, we propose a digital identity credential that allows for the creation of a “digital republic” in which enrollment in social benefits can be automated, and the benefits can be targeted to those most in need. While there are large potential population health and health disparities benefits that could arise from a digital republic, more empirical work is needed to understand the extent to which nations have benefited from digital identity programs in the past and the political economy associated with implementing such programs.