Commentary] 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. While many Americans struggle to pay taxes, few understand how difficult it can be for needy Americans to enroll in public social benefits such as Temporary Assistance for Needy Families (one of many income support programs), Pell grants (one of many tuition assistance programs), or Medicaid (one of many public health insurance programs). Perhaps because such programs are difficult to enroll in, only a fraction of needy families receive the social benefits to which they are entitled. That percentage is smaller for those most in need (e.g., those with disabilities or caregiving responsibilities). In this editorial, 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 card 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.