Funding Disparities Research Articles

Realizing the Goals of the Advancing American Kidney Health Initiative: Toward a Better Future for Kidney Disease Research Funding.

The Executive Order on Advancing American Kidney Health aimed to slow the progression of kidney disease, increase access to kidney transplantation, and expand home dialysis. In order to support the kidney health strategy laid out by the Advancing American Kidney Health, the National Institutes of Health, the National Institute of Diabetes, and Digestive, and Kidney Diseases, as well as other funding agencies must dedicate robust research funding to kidney disease. Currently, federal research investment for kidney health is less than 1% of Medicare fee-for-service expenditures for Americans with kidney disease. To address disparities in federal research funding, nephrology organizations are working together to advocate for increased federal commitment to kidney disease research. Underfunding of kidney disease research impedes scientific opportunities and innovation and prevents the collaboration of young investigators with research faculty that can accelerate the exodus of talent within the nephrology research workforce. This review provides an overview of the current state of federal research funding for kidney disease within the United States. In addition, we discuss ongoing advocacy efforts and programs that aim to increase federal funding for kidney-related research and accelerate the development of new and better therapies.

Lessons Learned from COVID-19: The Youth Sports World Going Forward.

The coronavirus disease 2019 pandemic profoundly impacted athletes and organizations of all ages and calibers. As optimism grows and restrictions lift, the mindset of youth sports shifts to prospection. Using the lessons learned during the cancelled, postponed, or modified 2020-2021 season, stakeholders should envision a different playing field moving forward. The void of youth sports highlighted the many values it brings to athletes physically, mentally, and socially. The regionality of sport during the pandemic highlighted resource and funding disparities among communities. Consideration must be given to the overall health of the student-athlete and how to return to competition and spectatorship safely and responsibly. The pandemic required youth sport to collaborate with public health with the hope of creating a semblance of normalcy in upcoming seasons. [Pediatr Ann. 2021;50(11):e470-e473.].

How to Reform Without Reforming: School District Racial Composition and Pennsylvania’s “Fair” Funding Formula

In the United States, researchers have documented persistent racial disparities in school funding for decades. Drawing on evidence from a recent policy change in Pennsylvania, this article contributes to research on the role of state governments in limiting or expanding racial disparities in K-12 education funding by examining differences in the racial composition of school districts positively and negatively impacted by a technical provision lawmakers inserted into a newly created formula for distributing state equalization aid. We find that negatively-impacted districts enroll a substantially higher number of Black and Latinx students, receive less state aid, have lower levels of state and local funding, and have lower spending levels than positively-impacted districts with otherwise similar financial needs. These findings suggest how state lawmakers can exacerbate racial inequities when pursuing reforms ostensibly focused on equity, and these results have implications for both policymakers and educational leaders focused on racial justice.

Addressing Racial Disparities in NIH Funding

The United States (US) must strategically invest in diversifying its biomedical workforce to retain global leadership in biomedical research and to reduce racial and ethnic disparities in the US. The under-representation of minority groups in the biomedical sciences is influenced by the National Institutes of Health (NIH) grant funding process which relies heavily on peer review subject to bias. Despite recent initiatives to combat structural racism within the NIH, the NIH has done little to rectify racial disparities in funding allocation that have been known for over a decade. In this report, I evaluate current NIH proposals to reduce bias in peer review and present stronger policy options for reducing inequity in grant funding. I recommend that the NIH treat the race/ethnicity funding disparity as it did the early career investigator disparity and immediately relax paylines and simultaneously prioritize research topics that align with interests of under-represented investigators, while working to develop a modified lottery for grant funding as a long-term solution to the biases that can influence grant peer review. Policies to address disparities in grant funding will diversify the biomedical workforce and have a profound and long-term positive impact on providing equitable access to science careers, regardless of race.

Three Wishes for Sickle Cell Disease: Results from a multi-stakeholder vision-casting project in Tennessee

Although sickle cell disease (SCD) is one of the most common genetic disorders in the US, disparities in research and funding persist. To better understand stakeholder priorities, we conducted a virtual vision-casting session utilizing a graphic recorder and content analysis. Stakeholders responded to the question: “If you had three magic wishes for SCD in TN, what would they be?”. Wishes for SCD centered around information and data, care and policy, and community. Better patient-centered information about treatments and modernization of data were high priorities. Stakeholders identified a need for heath equity, starting with lifetime continuity of care and access to curative treatment for all persons with SCD. Key points concerning the community included better patient inclusion in research, increased awareness, and greater public knowledge. SCD patients expressed a desire for honesty, transparency, compassion, and trust. Key areas to address in SCD include better data coordination, more influence on health policy, broader access to care and more community awareness, with the ultimate goal of improving the lives of persons with SCD. Using data to improve care and address health disparities will require researchers listening to stakeholders and understanding multiple perspectives to form unified goals.

Updated funding to lethality measures for National Cancer Institute funding allocation (2007-2017)

Objectives: To advocate for National Cancer Institute (NCI) funding more effectively, we quantified funding to lethality (F:L) ratios, tracked changes in those ratios over time, and compared F:L to other measures of funding allocation, including funding to incidence (F:I), funding to mortality (F:M) and funding to years of life lost (F:YLL) across 19 cancer sites. Methods: We used the NCI research portfolio database to assess funding allocated to 19 different cancer sites from the years 2007-2017. We collected incidence rates (I), mortality rates (M), and years of life lost (YLL) from the Surveillance, Epidemiology and End Results (SEER) database over the same 11 years. We defined lethality (L) by the formula (M/I x (YLLx100)). We calculated median yearly funding ratios and ranked them by cancer site. The correlations between funding ratios were accessed using Pearson correlation test. For each ratio, we calculated rate of change over time by cancer site using linear regression with year as the independent variable. To compare rates of change of each ratio by cancer site, we performed multivariable linear regression incorporating year, cancer site and their interaction as covariates, after applying a log10 transformation on the ratio to achieve linearity. The reference groups for comparison were the gynecologic cancer sites uterus, ovary and cervix. All analyses were completed in R, version 4.0.2. Results: The three cancer sites with the highest F:L ratio were breast, prostate and melanoma despite these being the 12th, 17th and 16th in terms of lethality. Ovary, uterus and cervix ranked 12th, 15th and 13th in F:L ratios, but were 5th, 13th and 6th in terms of lethality. The top three F:I were brain, leukemia, cervix; F:M were melanoma, Hodgkin's lymphoma, brain; and F:YLL were breast, prostate, lung. All three gynecologic cancer sites experienced negative rate of change of F:L over the 11 years. Ovary, cervix and uterus also experienced negative rate of change for F:I, F:M, and F:YLL with the only exception being ovary with positive change in F:M. F:L rates of change were significantly different for ovary, cervix and uterus compared to breast, melanoma, and prostate. F:L ratio was strongly positively correlated to F/YLL with Pearson correlation coefficient of 0.86 (p Conclusions: F:L ratios correlate with other funding allocation measures, and highlight inadequate NCI funding to gynecologic cancers. Trends of the last 5 years (2013-2017) are consistent with trends of the last 11 years. This data should be used for advocacy to improve the disparities in funding to GYN cancers that affect laboratory science discoveries, clinical trial availability and survival outcomes. Download : Download high-res image (296KB) Download : Download full-size image

NIH and National Foundation Expenditures For Sickle Cell Disease and Cystic Fibrosis Are Associated With Pubmed Publications and FDA Approvals

Sickle cell disease (SCD) and cystic fibrosis are both rare inherited diseases most often diagnosed in the United States by newborn screening. Early diagnosis and treatment have led to substantial improvements in survival, but adult mortality remains high with median survival of 40 to 45 years for sickle cell anemia and 35 to 40 years for cystic fibrosis. Disparities in funding between these two diseases of similar severity have been long recognized, but the relationship between funding and research productivity has not been rigorously evaluated. We hypothesized that expenditures by the NIH and the national foundations for these diseases would be associated with the number of publications indexed in PubMed, active clinical trials, and FDA approvals.We estimated disease-specific funding and number of career development awards using NIH RePORT (http://www.report.nih.gov/categorical_spending.aspx) and the Form 990 financial reports for expenditures by year for the Sickle Cell Disease Association of America and the Cystic Fibrosis Foundation and Cystic Fibrosis Foundation Therapeutics, Inc. We calculated expenditures per individual using published estimates of the number of people with SCD (89,079) and cystic fibrosis (30,000) in the United States. We developed a comprehensive search strategy with a medical informationist to identify relevant publications in PubMed and new postings of clinical trials (clinicaltrials.gov) by disease. We reviewed FDA approvals from 2009 to July 2013 to identify indications for SCD or cystic fibrosis.Funding per affected individual was 7.6 (2010) to 11.4 fold (2011) greater for cystic fibrosis than SCD and included a 3.5-fold higher NIH funding and 370 (2010) to 440 fold (2011) higher national foundation funding. NIH career development awards were similar for the two diseases despite nearly 3-fold more individuals affected by SCD. There were nearly twice as many publications and slightly more new listings of clinical trials for cystic fibrosis. No drugs were approved between 2010 and July 2013 for the treatment of SCD compared with 5 for cystic fibrosis.We confirmed widely disparate NIH and national foundation funding per individual affected by SCD and cystic fibrosis. Research productivity as measured by articles indexed in PubMed, new clinical trials, and new drug approvals were substantially higher for cystic fibrosis, despite similar severity to SCD and many fewer affected individuals in the United States. This likely reflects the increased financial resources available for research and quality improvement efforts.TableFunding and Research Productivity for Sickle Cell Disease and Cystic Fibrosis by Year.Sickle Cell DiseaseCystic FibrosisNIH Funding 2010$85,023,144$99,201,078NIH Funding 2011$65,094,922$78,861,688NIH Career Development Awards 20101514NIH Career Development Awards 20111618Foundation Funding 2010$1,399,062$122,135,426Foundation Funding 2011$1,185,023$176,209,849Per Person Funding 2010$970$7,378Per Person Funding 2011$744$8,502PubMed Publication 20108011553PubMed Publication 20118671556Clinical Trials 20102437Clinical Trials 20112625 Disclosures:Strouse:NIH: Research Funding; Doris Duke Charitable Foundation: Research Funding; Masimo Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding. Lanzkron:NIH: Research Funding. Haywood:NIH: Research Funding.

Highlighting disparities in public funding for student paramedics: Lee's story

Highlighting disparities in public funding for student paramedics: Lee's story

Does geographic spending variation exacerbate healthcare benefit inequality? A benefit incidence analysis for Indonesia.

The Indonesian government has made some ambitious steps to achieve Universal Health Coverage through the newly formed National Health Insurance [Jaminan Kesehatan Nasional (JKN)], establishing a single-payer insurance agency and prospective provider payment mechanism. This study aims to assess the benefit incidence of healthcare funding in the JKN era, and its distribution by socio-economic status considering regional variation in unit costs. We evaluate whether the benefit incidence of funding is skewed towards urban and wealthier households. We also investigate whether standard benefit incidence analysis using national unit costs underestimates regional disparities in healthcare funding. Lastly, we examine whether the design of the JKN provider payment system exacerbates regional inequalities in healthcare funding and treatment intensity. The analysis relies on Indonesia’s annual National Socio-economic Survey (Susenas) and administrative data on JKN provider payments from 2015 to 2017, combined at district level for 466 districts. We find that the benefit incidence of healthcare expenditure favours the wealthier groups. We also observe substantial variation in hospital unit costs across regions in Indonesia. As a result, standard benefit incidence analysis (using national average unit transfers) underestimates the inequality due to regional disparities in healthcare supply and intensity of treatment. The JKN provider payment seems to favour relatively wealthier regions that harbour more advanced healthcare services. Urban dwellers and people living in Java and Bali also enjoy greater healthcare benefit incidence compared to rural areas and the other islands.

Disparities in government and nonprofit organization funding may hinder clinical trial development for underfunded cancers.

1573 Background: National Cancer Institute (NCI) and nonprofit organization (NPO) funding is critical for research and advocacy, but may not be equitable across cancers. This could negatively impact clinical trial development for underfunded cancers. Methods: This study evaluated funding from the NCI and NPOs with > $5 million in annual revenue supporting leukemia, lymphoma, melanoma, lung, breast, colorectal, pancreatic, hepatobiliary, prostate, ovarian, cervical and endometrial cancers from 2015-2018 based on publically available reports and tax records. The primary objectives were to assess for disparities in NCI and NPO funding across different cancers compared to their median incidence and mortality from 2015-2018, and to determine if underfunding correlates with fewer clinical trials found in clinicaltrials.gov. Correlations between combined NCI and NPO funding for each cancer and its incidence, mortality and number of clinical trials were evaluated using descriptive statistics and Pearson correlation coefficients. Results: Diseases with the largest combined NCI+NPO funding were breast ($3.75 billion), leukemia ($1.99 billion) and lung cancer ($1.56 billion). Those with the least funding were endometrial ($94 million), cervical ($292 million), and hepatobiliary cancers ($348 million). These data are summarized in the Table. Disease-specific NCI+NPO funding correlated well with incidence, but less so with mortality (Pearson correlation coefficients: 0.74 and 0.63, respectively). Disease-specific NPO funding correlated moderately well with incidence, but was poorly correlated with mortality (Pearson correlation coefficients: 0.54 and 0.39, respectively). Breast cancer, leukemia and lymphoma were consistently well-funded compared to their incidence and mortality, while colorectal, lung, hepatobiliary and uterine cancers were consistently underfunded. The amount of NCI funding, NPO funding and combined NCI+NPO funding for a particular cancer each correlated strongly with the number of clinical trials for that disease (Pearson correlation coefficients: 0.88, 0.87 and 0.91, respectively). Conclusions: Many cancers with high incidence and mortality are underfunded. Cancers with higher mortality rates receive less funding, particularly from NPOs. Underfunding strongly correlates with fewer clinical trials, which could impede future advances in underfunded cancers.[Table: see text]

Gender disparities in National Institute of Health funding for hematologic malignancies, hematopoietic stem cell transplantation, and cellular therapeutics.

11020 Background: Gender inequality in research funding has been studied extensively; however, the literature lacks evidence in Hematology. We investigated trends in National Institutes of Health (NIH) funding for hematologic malignancies (HM), hematopoietic stem cell transplantation (HSCT), and cellular therapeutics (CT). Methods: The data on Hematology funding was retrieved from NIH Research Portfolio Online Reporting Tools (RePORT) Categorical Spending for fiscal years 2018 and 2019. A total of 6351 entries were reported. Only grants (n=1834) that were related to HM, HSCT, and CT were included. After excluding non-relevant, 975 principal investigators (PIs) were included in the analysis. Additional data regarding PIs was ascertained from the Scopus database, LinkedIn, Doximity, and departmental websites, including the number of publications, number of years of active research, H-index, highest degree, gender, and institution. Data were analyzed using SPSS version 21. Bivariate analyses, using chi-square and t-test, and linear regression analyses were performed. Results: In 2018 and 2019, 1834 grants totaling $799.4 million were awarded by the NIH for malignant hematology research (men 1301, 71% vs women 533, 29%). Of 975 PIs, 680 (70%) were men and 295 (30%) were women. Table highlights gender disparities in NIH funding and associated factors. Most of the grant recipients were Ph.D. or M.D./Ph.D. About 70% of total funding was awarded to male PIs. There were no gender differences in the mean number of grants and mean grant amount. Women had significantly lower years of active research and academic productivity. Conclusions: Although the gender gap in academic hematology has decreased in recent years, the latest trend suggests significant gender inequality in NIH funding for malignant hematology, transplantation, and cellular therapy.[Table: see text]

Gender Disparity in Grants and Awards at the National Institute of Health.

ObjectiveThe National Institute of Health (NIH) supports the academic career of scientists across the United States (U.S.). It promotes and sponsors scientists in conducting wide-ranging clinical and basic science research. Depending on the duration, research type, and budget, there are various types of grants awarded by NIH. Despite considerable advancement in biomedical sciences, female researchers remain underrepresented in obtaining NIH funding. Through this study, we aim to highlight the gender trends in NIH funding and grants. By doing this, we aim to facilitate effective future policymaking to help achieve gender parity in NIH grants and awards.MethodsThe data were obtained from the NIH Research Portfolio Online Reporting Tool (RePORT). The extracted data by gender were tabulated showing percentages of females as Research Grant Investigators, Research Career Development Award Recipients and Kirschstein-National Research Service Award (NRSA) Trainees and Fellows, recipients of Research Grants, Research Project Grants (RPGs), and R01 equivalent grants including types 1 or 2, over two decades (1999-2019). Absolute percentage change was also calculated and included in the tables.ResultsThe percentage of females as NIH Research Grant Investigators has increased at centers, research centers as well as for RPGs and Small Business Innovation Research and Small Business Technology Transfer (SBIR/STTR) programs. For Research Career Development Award Recipients and Kirschstein-NRSA Trainees and Fellows, the proportion of female pre-doctoral institutional trainees, post-doctoral fellows, post-doctoral institutional trainees, mentored research career awardees, and other research career awardees have steadily increased. However, there was a decrease in the percentage of female pre-doctoral fellow awardees. The percentage of females receiving all RPGs, R01-New (type 1) and R01-Renewal (type 2) grants has also decreased. ConclusionDespite an overall increase in the percentage of female researchers successfully receiving NIH grants and awards, they continue to lag compared to their male counterparts. With the increasing number of female doctoral graduates, it is imperative to address this disparity in NIH funding.

Associations of topic-specific peer review outcomes and institute and center award rates with funding disparities at the National Institutes of Health.

A previous report found an association of topic choice with race-based funding disparities among R01 applications submitted to the National Institutes of Health ('NIH') between 2011 and 2015. Applications submitted by African American or Black ('AAB') Principal Investigators ('PIs') skewed toward a small number of topics that were less likely to be funded (or 'awarded'). It was suggested that lower award rates may be related to topic-related biases of peer reviewers. However, the report did not account for differential funding ecologies among NIH Institutes and Centers ('ICs'). In a re-analysis, we find that 10% of 148 topics account for 50% of applications submitted by AAB PIs. These applications on 'AAB Preferred' topics were funded at lower rates, but peer review outcomes were similar. The lower rate of funding for these topics was primarily due to their assignment to ICs with lower award rates, not to peer-reviewer preferences.

An Investigation to Explain Structural Racism Associated with Michigan Public Charter Districts Funding Effort

The research objective is to explain evidence of structural racism, inequity, and inadequacy in the Michigan public school finance system related to the education of Black students or Black descendants of captive and enslaved Africans. This analysis stems from ongoing research that integrates transformative paradigms, critical race theory, and school funding fairness to explain systemic racism associated with public school funding policy, practice, and educational disparities. The Constitution of the State of Michigan of 1963, Article 9, Sections 3, 5, 8, 11, and 36 (commonly known as Public Act 145 of 1993 or Proposal A), Michigan’s school funding policy, sought to decrease local property taxes and rid the system of funding inequalities across school districts. The legislation’s intention was to achieve four basic goals: (1) reduce property tax burdens; (2) reduce per pupil funding disparities; (3) limit annual increases in property tax assessments and (4) increase site control over local school district finances. As a result, Proposal A (1993) eliminated local school property taxes due to public outcry regarding increasing rates, resulting in a reduction of nearly $7 billion in funding for Michigan’s public schools, beginning in the 1994–95 school year. Proposal A sought to improve the equalization and equity in funding across school districts. This examination uses the lens of critical race theory (CRT) to analyze Michigan’s Proposal A to understand better the unique interplay among the political, economic, and ideological forces influencing public school finance. CRT explains the inherent inequities due to racial, ethnic, and class lines deeply inserted in U.S. society and the public school system. This investigation presents quantitative evidence from Michigan public school data showing that Black students who receive free and reduced lunch (FRL) are overrepresented in charter districts in Michigan. Although students in these schools require greater resources than their peers to achieve similar academic outcomes, Michigan’s charter districts receive less revenue from state and local sources. As a result, Michigan’s charter financing system reinforces racial and socioeconomic inequality by providing less per-pupil funding to Black and FRL students.

Persistent disparities in smoking among rural Appalachians: evidence from the Mountain Air Project.

BackgroundAdult smoking prevalence in Central Appalachia is the highest in the United States, yet few epidemiologic studies describe the smoking behaviors of this population. Using a community-based approach, the Mountain Air Project (MAP) recruited the largest adult cohort from Central Appalachia, allowing us to examine prevalence and patterns of smoking behavior.MethodsA cross-sectional epidemiologic study of 972 participants aged 21 years and older was undertaken 2015–2017, with a response rate of 82%. Prevalence ratios and 95% confidence intervals for current smoking (compared to nonsmokers) were computed for the entire cohort then stratified by multiple characteristics, including respiratory health. Adjusted prevalence ratios for current smoking versus not smoking were also computed.ResultsMAP participants reported current smoking prevalence (33%) more than double the national adult smoking prevalence. Current smoking among participants with a reported diagnosis of chronic obstructive pulmonary disease and emphysema was 51.5 and 53.3%, respectively. Compared to participants age 65 years and older, those age 45 years or younger reported double the prevalence of smoking (PR: 2.04, 95% CI: 1.51–2.74). Adjusted analyses identified younger age, lower education, unmet financial need, and depression to be significantly associated with current smoking.ConclusionsDespite declining rates of smoking across the United States, smoking remains a persistent challenge in Central Appalachia, which continues to face marked disparities in education funding and tobacco control policies that have benefitted much of the rest of the nation. Compared with national data, our cohort demonstrated higher rates of smoking among younger populations and reported a greater intensity of cigarette use.

Fund Black scientists

Our nationwide network of BME women faculty collectively argue that racial funding disparity by the National Institutes of Health (NIH) remains the most insidious barrier to success of Black faculty in our profession. We thus refocus attention on this critical barrier and suggest solutions on how it can be dismantled.

Racial inequity in grant funding from the US National Institutes of Health.

Biomedical science and federal funding for scientific research are not immune to the systemic racism that pervades American society. A groundbreaking analysis of NIH grant success revealed in 2011 that grant applications submitted to the National Institutes of Health in the US by African-American or Black Principal Investigators (PIs) are less likely to be funded than applications submitted by white PIs, and efforts to narrow this funding gap have not been successful. A follow-up study in 2019 showed that this has not changed. Here, we review those original reports, as well as the response of the NIH to these issues, which we argue has been inadequate. We also make recommendations on how the NIH can address racial disparities in grant funding and call on scientists to advocate for equity in federal grant funding.

Disclosures in Equity

While one might expect that the nonprofit sector is an equitable space where generosity and social justice are the norms, the sector suffers from funding inequalities. Despite corporations’ and private foundations’ pledges to fund nonprofit organizations that are led by members of, or that serve, communities of color, there are racial disparities in nonprofit funding. Research reveals that in comparison to White-led nonprofit organizations, organizations led by or serving communities of color are chronically underfunded. These disparities in funding mean that organizations that serve communities of color are more likely to go defunct or lack resources. Increased funding for minority-led or serving organizations can have a profound positive impact on the criminal justice system, healthcare, environmental justice, housing, labor, and employment. Indeed, it would be difficult to fight mass incarceration without the work of nonprofit charities like Bryan Stevenson’s preeminent organization, Equal Justice Initiative. This Article proposes two novel remedies to address this issue. The first is for charities to publicly disclose their institutional donors in Schedule B of Internal Revenue Service (“IRS”) Form 990. The second is for IRS Form 990 to include information on the race and ethnicity of top managers, directors, and the communities an organization serves. Mandating these disclosures would allow the public to assess whether pledges to support racial justice come with funding rather than empty promises. While the Supreme Court’s recent case, Americans for Prosperity Foundation v. Bonta (“AFPF”) struck down California’s donor disclosure requirements, this Article makes an important distinction between individual and institutional donors that the AFPF case ignores. As the disclosures would only apply to institutional donors and would include an opt out provision for controversial organizations, they would protect the right to freedom of association while promoting transparency in nonprofit funding and racial justice. By using mandatory disclosures to address racial inequities in not-for-profit law, the nonprofit sector might finally contend with persistent racial disparities in funding that leave communities of color underserved.

School Finance, Race, and Reparations

In this article we explain why and how school finance reform should be a part of a reparations program for Black Americans. This article proceeds in six parts. Part I explains how Black-white school funding disparities occurred during the separate-but-equal era. Part II discusses how these funding disparities have occurred in the aftermath of the Brown decision. Parts III and IV explore why school desegregation and school finance litigation, respectively, have failed to remedy these gaps. Part V lays out a reparations framework that state legislatures could adopt to provide restitution to schools and taxpayers harmed by state policies creating Black-white racial funding disparities. Part VI discusses the role that the federal government could play in a school finance reparations program.

Pay to skip the line: The political economy of digital testing services for HIV and other sexually transmitted infections.

The value of digital healthcare has been lauded in Canada at local, provincial, and national levels. Digital medicine is purported to enhance patient access to care while promising cost savings. Using institutional ethnography, we examined the potential for publicly funded digital testing for HIV and other sexually transmitted infections (STI) in Ontario, Canada. Our analyses draw from 23 stakeholder interviews with healthcare professionals conducted between 2019 and 2020, and textual analyses of government documents and private, for-profit digital healthcare websites. We uncovered a "two-tiered" system whereby private digital STI testing services enable people with economic resources to "pay to skip the line" queuing at public clinics and proceed directly to provide samples for diagnostics at local private medical labs. In Ontario, private lab corporations compete for fee-for-service contracts with government, which in turn organises opportunities for market growth when more patient samples are collected vis-à-vis digital testing. However, we also found that some infectious disease specimens (e.g., HIV) are re-routed for analysis at government public health laboratories, who may be unable to manage the increase in testing volume associated with digital STI testing due to state budget constraints. Our findings on public-private laboratory funding disparities thus discredit the claims that digital healthcare necessarily generates cost savings, or that it enhances patients' access to care. We conclude that divergent state funding relations together with the creeping privatisation of healthcare within this "universal" system coordinate the conditions through which private corporations capitalise from digital STI testing, compounding patient access inequities. We also stress that our findings bring forth large scale implications given the context of the global COVID-19 pandemic, the rapid diffusion of digital healthcare, together with significant novel coronavirus testing activities initiated by private industry.