A new study found low-income people were more likely than other groups to use telehealth services during the pandemic, proving that telehealth does increase access to needed care for underserved people.
Telehealth use skyrocketed during the pandemic when restrictions around telehealth use were eased. In particular, Medicare expanded the number of services allowed to be delivered via telehealth and allowed greater flexibility with the acceptable technology platforms providers could use, even expanding audio-only services. However, though audio-only services are an important part of telehealth, video-enabled telehealth allows for a better patient interaction and may be better in many clinical situations.
The study found that people earning less than $25,000 were more likely to use audio-only services and less likely to have video appointments than other groups. Without addressing barriers like unequal broadband distribution and limited access to video-capable devices, telehealth won’t live up to its potential.
Using data from the Census Bureau’s Household Pulse Survey from April to October 2021, researchers at HHS’ office of Assistant Secretary for Planning and Evaluation (ASPE) found that a quarter of respondents reported using telehealth in the previous four weeks. While there was some variation across demographic groups, the most significant disparities were between those who used audio versus video telehealth services.
Video telehealth rates were higher among young adults ages 18 to 24 (72.5% reported using video telehealth), those earning at least $100,000 (68.8%), those with private insurance (65.9%), and white individuals (61.9%). Conversely, video telehealth use was lowest among those without a high school diploma (38.1%), adults ages 65 and older (43.5%), and Latino (50.7%), Asian (51.3%), and Black individuals (53.6%).
For people without access to broadband internet, phone visits can make it easier to access to care. But video appointments allow for more physical examination, better communication, and a more substantial patient-provider relationship. Further, a video connection allows a provider to have a glimpse into the patient’s home where some social indicators may increase understanding of a patient’s health condition.
But video appointments require video-capable devices, broadband access, software literacy, and often English proficiency. These all prevent barriers for older patients, lower-income patients, non-English speaking patients, and those who don’t have privacy in their homes.
The report underscores the urgency of bringing high-speed broadband to everyone, so that telehealth doesn’t become another example of health disparities where only the relatively affluent can take full advantage of the easy access and lower costs digital health enables. While Medicare has decided to permanently cover audio-only mental health visits if the patient doesn’t have access to video capable devices, a video connection allows for more expansive clinical evaluation for other types of care. Payers should not limit access to audio-only services at this time, but rather should push for broadband expansion so that more people can access video-enabled care.
