Paper short abstract:

I use an India-wide household panel to explore healthcare marginalisation among digitally excluded and included groups in rural areas. I find that phone diffusion creates a struggle that sharpens the elbows of those who are able to use the devices—provided the health system permits such use.

Paper long abstract:

While it is increasingly acknowledged that technology diffusion can be uneven, the research on mobile phone diffusion continues to view the rapid spread of mobile phones in low- and middle-income countries as generally beneficial and the process of digital inclusion as unproblematic. This study explores healthcare marginalisation among digitally excluded and included groups in rural India, thereby aiming to contribute to an important yet surprisingly under-researched aspect of the social implications of mobile technology diffusion.

I use recent panel data from the nationwide Indian Human Development Survey. My analysis links healthcare access to changes in rural household-level phone ownership among 12,003 households 2004-2012. I find that households who do not acquire mobile phones have worse, and households with mobile phones have better, access to healthcare for major illnesses where phones have otherwise diffused widely within the same district. This indicates that the healthcare system gradually adapts to increasing mobile phone use at the expense of non-users, which suggests that rapid mobile phone diffusion can rein-force rather than ameliorate existing patterns of marginalisation.

I conclude that rapid mobile phone diffusion creates an opportunity to improve people's access to healthcare in rural India, but it also creates a struggle. It sharpens the elbows of those who are able to use phones vis-à-vis those who are not—provided the health system permits such use. Health system adapta-tion to phone use can in turn result into a "tyranny of inclusion," making the uptake of phones necessary to retain access to care.

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