Keeping Telehealth an Equalizer in the Age of COVID (Preprint)

BACKGROUND Telehealth has historically been used to increase access to care for marginalized populations living in rural and underserved communities and those that require frequent medical care. Video visits have been used to address distance barriers for routine and specialty care and remote patient monitoring has been used to help those with chronic medical conditions. However, following the COVID pandemic, telehealth is standard and less likely to be used by populations that could benefit most from its use. OBJECTIVE The objective of this review is to evaluate whether telemedicine use is lower among patients without insurance, racial/ethnic minorities, and non-English speaking patients. METHODS From reviews of the literature and USA data, comparisons of telehealth use between different populations were conducted. Utilization rates were compared between racial/ethnic groups (Black-Asian-White and Hispanic-Non-Hispanic) and among different telehealth use cases: on-demand direct to consumer care; scheduled ambulatory video visits; and remote patient monitoring applications. RESULTS Among telehealth users in the USA, the highest share of visits that utilized video services occurred among young adults ages 18 to 24 (72.5%), those earning at least $100,000 (68.8%), those with private insurance (65.9%), and White individuals (61.9%). Video telehealth rates were lowest among those without a high school diploma (38.1%), adults ages 65 and older (43.5%), and Hispanic (50.7%), Asian (51.3%) and Black individuals (53.6%). CONCLUSIONS Telehealth use increased dramatically during the COVID-19 pandemic, but research suggests that access to telehealth was not equitable across different population subgroups. Following the pandemic, the use of telehealth has gone from a tool that was used to primarily address barriers in access among minority populations to a model of care that serves those that are better insured, English speaking, and White. Interventions to address inequities involve payment policies, ambulatory operations, and investments in making telehealth more accessible by underserved populations.