Socioeconomics and politics: Concerns or issues related to the political boundaries, governing, and ideologies of a region, as well as a resident’s financial, educational, occupational, and social status. The sub-topics are
Country or region
Economics
In this context, “politics” refers to the governmental systems that decide health care and social policy. Even countries with similar cultures may require very different adaptations depending on how their healthcare systems are set up. The ability of a country’s residents to afford assistive technology will also affect adoption. Therefore, the associated sub-topics are:
Click on the buttons below to view the socioeconomic and political questions and examples for each sub-topic.
Country or Region
| Question | Example | Self-Feeding Device | Glucose Monitoring App |
|---|---|---|---|
| What adaptations would be necessary to ensure that the assistive technology will work in developing countries or communities? | Developing countries may not have cell phone towers, so apps or any web-based technology won’t work. Many devices need associated services like fitting and training, which are often unavailable. | The OBI device plugs in to an outlet for recharging, so there must be access to electricity. In addition, it is sensitive to temperature, so it should only be used in environments between 13-30 degrees C. | Many areas don’t have access to the internet, so unless the app doesn’t need the internet once it has been downloaded, the app is not an option for millions of people with diabetes. |
| How can the voltage and plug shape be safely adapted? | A device that requires a wall plug would need different adaptors depending on its region. Most North American appliances work at 110 volts, but most other regions use 220-240. Any device that uses heat would probably not be able to use a common voltage converter and would need to have something built in. | Adaptors are available for the OBI device, facilitating travel. | When traveling abroad, the user will need an outlet adaptor. Their mobile network may not work across international boundaries, or there may be a fee. |
| In the situation of assistance through professional caregivers, how do licensing requirements and caregiver training change according to the country or region, and how would that training affect a caregiver’s ability to assist the technology user? | Countries have a variety of access to trained professionals, and those trained professionals do not always have the necessary skills to manage and teach clients how to manage certain conditions. | A professional would need to be involved to recognize if the user needed more help than the device was able to provide, or if the user’s chewing and swallowing ability meant the OBI was no longer a safe option. | If the user does not have proper training by a medical professional, he/she might not be aware that glucose monitoring apps are an option. |
| What are the costs associated with getting the device to the user, including shipping costs and methods? | A device may difficult or expensive to ship, particularly if the user is in a remote area or a place for away from where the technology is produced . Bulky items can sometimes be broken down into parts for ease of shipping, but may be difficult to put back together. | In Canada, there are charities that offer financial aid for the cost of assistive devices, including shipping costs. | Downloading an app would have to be done through an online account. Users would need to have an iTunes or Google Play account linked to a credit card in order to get the app. If the app would be covered by some kind of insurance, the user would have to apply for reimbursement. Some apps may not be accessed in certain countries. |
| If patient information is being collected, how is it separated from the user's identity, and on what country's server are the data stored? | Anything stored on a U.S. server is subject to U.S. privacy laws, which may offer the user less protection than other countries’ laws especially for non-U.S. citizens. | N/A | Most apps save customer data. Many also track the user’s location and/or ask for access to a person’s social media accounts, phone, and camera. Any app with U.S. servers would make users’ information available to the government in accordance with U.S. privacy laws. Some countries may not allow the use of an app due to censorship. |
| Is the patient still working, or will be expecting to work, meaning that a device may be needed in more than one environment? | Retirement ages depend on the country of origin (retirement age) and financial security. Some demographics will need to work longer, requiring assistance from a device both at home and at work. | The devices is able to be transported, but will need a caregiver for setup. | Some workplaces prohibit phones from being used during the workday, or prevent phones from being in a facility due to security concerns. Would the app work on a desktop computer instead? |
| Will the device be allowed to cross international borders? | An app may rely on tech platforms that are blocked in certain countries. Devices may be restricted across international borders: A UV therapy wand that is available over the counter in Canada requires a prescription in the U.S. | The device would need to be inspected during air travel. People from demographics that are often targets of profiling may not want to carry a device that would draw further attention to themselves. | Some apps are prohibited in certain countries. China prohibits Google Play altogether. |
| What kind of regulatory approval would be required, if any? | In the U.S., personal transportation devices do not require FDA approval, but medical devices do (e.g., a customizable wheelchair). | The OBI is an FDA-registered Class-1 Medical Device. | Apps that intend to treat or prevent disease may need a country’s regulatory approval, resulting in many more complications for the designer. |
| What kind of community infrastructure is required to use/support the healthcare technology? | One may need services/infrastructure such as paved roads/sidewalks, high-speed Internet, a landline phone, or constant electricity to effectively use the healthcare technology. This kind of infrastructure might be difficult to access in settings such as developing countries or remote communities. | The device may be affected by the table height when dining. | To run an app, the user needs access to a smartphone or tablet, electrical outlet, the internet, and a phone plan with data. |
Economics
| Question | Example | Self-Feeding Device | Glucose Monitoring App |
|---|---|---|---|
| What are the funding sources available to pay for the assistive technology? How does that differ according to location? | Insurance coverage can vary widely even within the same country. Private insurance companies may want to negotiate better rates for their customers, so the costs can vary widely across portions of the population both with and without medical insurance. In order to be funded by insurance, the tech manufacturer will need to be able to prove that their innovation is a good value and can prevent more expensive uses of healthcare services. | In the U.S., Medicare part B will cover up to 80% of an assistive feeding device. Other insurance companies may offer better or worse coverage. | Many apps are free with reduced functionality or for a limited time, so a user would need to consider long-term costs of the app. |
| What is the planned lifetime of the device? How would the funder replace or repair the device? | Local health insurance coverage may vary across regions of a country. There would need to be enough technicians in a range of areas who have the knowledge to repair the device. The cost will vary by region. | Batteries may need to be replaced. A replacement spoon, plate, and placemat are available for purchase if needed. | App updates will need to be updated periodically, so a user will need a new phone in eventually in order to keep up with the app’s requirements. Upgrades may require another purchase. |
| How can the device be accessible to those with a low socioeconomic status (SES)? | Countries with universal healthcare may enable a larger percentage of people to afford AT, but there are limits and inconsistencies to the kinds of ATs that insurance will provide. Countries with limited access to insurance will force people to face high out-of-pocket prices. | Some charitable organizations are willing to provide assistance for the purchase of assistive devices. | A person with a low socioeconomic status may not own a smartphone. They may not have an adequate data plan or access to a wifi network. |
| How can updates to apps/software be made in a way that they will continue working with older operating systems/devices? | A person with an older iPhone may not have the same power or storage capabilities as someone with a new iPhone. Older devices may have shorter battery spans. | N/A | A user would not want to have to purchase a new phone in order to keep up with app updates. They would also be likely to get upset if the app charges more for additional features that are developed. |
| Would the device have a warranty? For how long? | Warranties may protect the user against device failure, since insurance may only provide a replacement after a certain amount of time has passed. | The OBI robot has a 1-year limited warranty, although extensions are available. | N/A |