The response to COVID-19 has involved an unprecedented expansion in telehealth. While older Americans and minority populations among others are known to be disadvantaged by the digital divide, few studies have examined disparities in telehealth specifically, and none during COVID-19. This study uses data from a large health system in NYC – the initial epicenter of the US crisis – to describe characteristics of patients seeking COVID-related care via telehealth, ER, or office encounters during the peak pandemic period. Demographic factors are significantly predictive of encounter type. Of any age group, patients 65+ had the lowest odds of using telehealth versus other modalities. By race and ethnicity, Black and Hispanic patients have lower odds of using telehealth versus either the ER or an office visit than either Whites or Asians – this remains true even after adjusting for age, comorbidities and preferred language. Additional research into sociodemographic heterogeneity in telehealth use is needed to prevent potentially further exacerbating health disparities overall.

Results: Texans use hospital-based EDs and urgent care centers much more than freestanding EDs, but freestanding ED utilization increased 236% between 2012 and 2015. The average price per visit was lower for freestanding EDs versus hospital-based EDs in 2012 ($1,431 versus $1,842), but prices in 2015 were comparable ($2,199 versus $2,259). Prices for urgent care centers were only $164 and $168 in 2012 and 2015. Out-of-pocket liability for consumers for all these facilities increased slightly from 2012 to 2015. There was 75% overlap in the 20 most common diagnoses at freestanding EDs versus urgent care centers and 60% overlap for hospital-based EDs and urgent care centers. However, prices for patients with the same diagnosis were on average almost 10 times higher at freestanding and hospital-based EDs relative to urgent care centers. Conclusion:Utilization of freestanding EDs is rapidly expanding in Texas. Higher prices at freestanding and hospitalbased EDs relative to urgent care centers, despite substantial overlap in services delivered, imply potential inefficient use of emergency facilities.

Key Points Question Was the first wave of the coronavirus disease 2019 (COVID-19) pandemic associated with exacerbated racial/ethnic disparities in preterm birth in New York City? Findings This cross-sectional study found that racial/ethnic disparities in very preterm birth and preterm birth among 8026 women were similar during the first wave of the COVID-19 pandemic in New York City compared with the same period the year prior. Meaning Monitoring of racial/ethnic disparities in adverse birth outcomes as the COVID-19 pandemic continues is warranted.

Retail clinics have been viewed by policy makers and insurers as a mechanism to decrease health care spending, by substituting less expensive clinic visits for more expensive emergency department or physician office visits. However, retail clinics may actually increase spending if they drive new health care utilization. To assess whether retail clinic visits represent new utilization or a substitute for more expensive care, we used insurance claims data from Aetna for the period 2010-12 to track utilization and spending for eleven low-acuity conditions. We found that 58 percent of retail clinic visits for low-acuity conditions represented new utilization and that retail clinic use was associated with a modest increase in spending, of $14 per person per year. These findings do not support the idea that retail clinics decrease health care spending.

ObjectiveTo examine the between-hospital variation of charges and discounted prices for uncomplicated vaginal and caesarean section deliveries, and to determine the institutional and market-level characteristics that influence adjusted charges.Design, setting and participantsUsing data from the California Office of Statewide Health Planning and Development (OSHPD), we conducted a cross-sectional study of all privately insured patients admitted to California hospitals in 2011 for uncomplicated vaginal delivery (diagnosis-related group (DRG) 775) or uncomplicated caesarean section (DRG 766).Outcome measuresHospital charges and discounted prices adjusted for each patient's clinical and demographic characteristics.ResultsWe analysed 76 766 vaginal deliveries and 32 660 caesarean sections in California in 2011. After adjusting for patient demographic and clinical characteristics, we found that the average California woman could be charged as little as US$3296 or as much as US$37 227 for a vaginal delivery, and US$8312–US$70 908 for a caesarean section depending on which hospital she was admitted to. The discounted prices were, on an average, 37% of the charges. We found that hospitals in markets with middling competition had significantly lower adjusted charges for vaginal deliveries, while hospitals with higher wage indices and casemixes, as well as for-profit hospitals, had higher adjusted charges. Hospitals in markets with higher uninsurance rates charged significantly less for caesarean sections, while for-profit hospitals and hospitals with higher wage indices charged more. However, the institutional and market-level factors included in our models explained only 35–36% of the between-hospital variation in charges.ConclusionsThese results indicate that charges and discounted prices for two common, relatively homogeneous diagnosis groups—uncomplicated vaginal delivery and caesarean section—vary widely between hospitals and are not well explained by observable patient or hospital characteristics.