Examining the Rise of Telehealth During COVID-19

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Although telehealth has been a more affordable and convenient option at patients’ disposal for quite some time, its prominence rose after it was thrust into the spotlight during the COVID-19 pandemic. During this time, it gained popularity because of its ability to minimize risk for both patients and healthcare providers, due to how contagious the SARS-CoV-2 virus is.

An investigation published in JAMA Network Open¹ explored the disparities that developed when it came to accessing telehealth services during the pandemic, and also, to what degree having high-speed internet (which the Federal Communications Commission defined as living in a census block group with a median block maximum download speed of 940 megabits per second or greater), impacted these aforementioned gaps.

Other than eliminating geography and transportation as barriers, the authors argue that telehealth can also help close the socioeconomic status (SES), age, race, and rurality gap, but one must also remember that such a service requires digital literally, equipment, and access to the internet. There revolve around the aforementioned disparities in ability to access and use digital technologies that exist, which is also known as the “digital divide.”

“Over one-quarter of the US population lacks broadband in their homes, concentrated among individuals with annual incomes less than $30 000,” the study authors wrote. “However, the degree to which internet access moderates the effect of social determinants on telehealth utilization remains unclear. Moreover, while literature has examined telehealth expansion within the Medicaid program, little research has described the association between broadband access and telehealth utilization within Medicaid.”

The study authors pulled data from Wisconsin Medicaid enrollment and claims that were dated Dec.1, 2018, to Dec. 31, 2021, which included 172,387 participants, all of whom were non-pregnant, nondisabled adults aged between 18 and 64 years of age, who were eligible for Wisconsin Medicaid as parents, caretakers, or childless adults.

The breakdown was as follows: 102,989 (59.7%) were female, 103, 848 (60.2%) were non-Hispanic White, 34,258 (19.9%) were non-Hispanic Black, 15,020 (8.7%) were Hispanic, and 104,239 (60.5%) were aged 26-45 years.Per the data, Hispanic participants had a greater increase in telehealth visits than Non-Hispanic White participants.

When it came to location, urban participants had a greater increase in telehealth visits than rural participants, which could be logical, given that the majority of participants (112,355, or 66.0%) reported living in an urban county, with a high school education or greater (100,494 participants, or 59.4%), and with an income 50% or less of the federal poverty level (109,796 participants, or 61.1%). Overall, 142,433 individuals (82.6%) had access to high-speed internet (HSI), and 72, 524 people (42.1%) reported having a chronic condition.

Analysis also determined that prior to the public health emergency (PHE) period, which ran from June 1, 2019 to Feb. 29, 2020, visit rates were notably higher for female than male participants, non-Hispanic White than non-Hispanic Black individuals, urban than rural residents, those with HSI than low-speed internet (LSI), and patients with chronic disease than patients without.

As a result, noted that authors, “… greater telehealth uptake occurred in groups with higher pre-PHE utilization, except for high uptake among Hispanic and non-Hispanic Black individuals despite low pre-PHE utilization. HSI did not moderate disparities. These findings suggest telehealth and HSI may boost PC receipt, but will generally not close utilization gaps.”

In other words, it is unlikely that expanding telehealth offerings or access to HSI will close the gaps in utilization of these primary care services.

“Although telehealth expansion has been touted as a low threshold policy intervention to expand access to care, leveraging telehealth to improve access for underserved populations will require more nuanced attention to the specific mechanisms linking telehealth and health care utilization to avoid inadvertently deepening disparities for select populations,” the study authors concluded.

Reference

1. Tilhou AS, Jain A, DeLeire T. Telehealth Expansion, Internet Speed, and Primary Care Access Before and During COVID-19. JAMA Netw Open. 2024;7(1):e2347686. doi:10.1001/jamanetworkopen.2023.47686