Telehealth and Health Equity: Analyzing the Impact of State Telehealth Policies on the Use of Telehealth Services Among Vulnerable Populations During the COVID-19 Pandemic

Abstract

Telehealth is defined as the delivery of health education, information, and services via remote technologies, and, prior to the spring of 2020, it was primarily used to provide care to patients living in medically underserved rural areas. Nevertheless, after the declaration of the public health emergency, state and federal governments temporarily waived several telehealth restrictions allowing patients across the country to receive care remotely. These flexibilities permitted the use of telephones to access telehealth services. They also expanded the kinds of primary and specialty care services that can be delivered virtually as well as the types of clinicians who can deliver them. Lastly, insurers were required to reimburse for virtual visits at the same rate as in-person visits to promote the use of telehealth. These and many other temporary measures led to the widespread use of virtual care, which is increasingly becoming popular both among patients and providers. As a result, lawmakers are considering making some of these flexibilities permanent, but this is proving to be quite difficult since there are many uncertainties regarding the cost, quality, and security of telehealth.

Although most of the current research on this topic primarily focuses on the problems listed above, this thesis takes a different approach and examines whether or not there is equitable access to telehealth because it is also an important issue to consider when developing long-term telehealth policies. As such, it uses data from a nationally representative survey to assess the variations in the level of telehealth utilization across different demographic groups. It also explores the association between certain telehealth policies and telehealth utilization rates among vulnerable patient populations to determine which policies promote health equity.

The thesis ultimately finds that there are disparities in the use of telehealth. After controlling for internet and computer accessibility, patients who are uninsured, male, and have a low socioeconomic status were significantly less likely to have a telehealth visit. There were also variations in the types of telehealth visits patients had because low socioeconomic status, housing insecurity, old age, and non-White racial status were all correlated with having an audio-only telehealth visit rather than a video-based one. Lastly, the regression analysis also shows that flexible telehealth policies were associated with increased telehealth utilization rates among the overall population as well as vulnerable subpopulations. Medicaid and private payer policies that allow audio-only telehealth, expand the types of health professionals who can provide virtual care as well as those that require virtual visits to be reimbursed at the same rate as in-person visits were particularly important predictors of telehealth utilization.

With these findings in mind, this thesis makes four key policy recommendations regarding the types of telehealth laws that need to be enacted permanently. It also provides suggestions on how to reduce existing disparities in telehealth while also ensuring its affordability, quality, and security.