Are State Telehealth Policies Associated With The Use Of Telehealth Services Among Underserved Populations?

Abstract

Using four years of data from a nationally representative consumer survey, we examined trends in telehealth usage over time and the role state telehealth policies play in telehealth use. Telehealth use increased dramatically during the period 2013-16, with new modalities such as live video, live chat, texting, and mobile apps gaining traction. The rate of live video communication rose from 6.6 percent in June 2013 to 21.6 percent in December 2016. However, underserved populations-including Medicaid, low-income, and rural populations-did not use live video communication as widely as other groups did. Less restrictive state telehealth policies were not associated with increased usage overall or among underserved populations. This study suggests that state efforts alone to remove barriers to using telehealth might not be sufficient for increasing use, and new incentives for providers and consumers to adopt and use telehealth may be needed.

Prevalence and Characteristics of Telehealth Utilization in the United States

“…Although our data are more recent than many efforts to assess telehealth adoption, we found lower rates of use of videoconferencing visits (vs an approximate range of 4%-22% in other studies) and less willingness to use it compared with other general population surveys and industry polls. 7 , 8 , 9 , 14 Differences in findings may be attributable in part to how samples are constructed. For example, a nationally representative survey conducted in 2015 to 2016 by the Association of American Medical Colleges only included adults who had a need for medical care in the past 12 months.…”

“…Following an environmental scan of existing surveys 5 , 6 , 7 , 8 , 9 and their instruments, where available, we developed 4 telehealth-related questions gathering data on (1) use of different telehealth modalities at any point in the past; (2) use of telephone or video conferencing visits in the past year and whether the visit(s) was with a familiar or unfamiliar physician; (3) reasons for not using videoconferencing visits; and (4) willingness to use videoconferencing visits (using a 5-point Likert scale). Survey questions are included in the eAppendix in the Supplement .…”

“…3 , 4 However, until the coronavirus disease 2019 (COVID-19) pandemic began in March 2020, use of telehealth was relatively rare, and estimates of telehealth adoption in the US were variable and had numerous limitations. 5 , 6 , 7 , 8 , 9 For example, studies commonly focused on only 1 form of telehealth, used inconsistent definitions of telehealth, and/or engaged small, nonrepresentative samples. Also, commonly cited statistics on telehealth utilization usually came from market research studies sponsored by organizations with a financial interest in suggesting telehealth use is high.…”

Forecasting Limited Access to Urology in Rural Communities: Analysis of the American Urological Association Census

“…35,36 There is already evidence that the rural patients most likely to benefit from telemedicine are not those participating. 37 A realignment of patient education, financial incentives, and friendly legal environment may be required to increase use.…”

Bringing health care to the patient

“…Canada's eHealth Infostructure Program seeks to modernise and improve health care services in First Nations communities, using in part telehealth. In 2017, the Ontario Telemedicine Network included 120 indigenous telemedicine sites and counted 9 628 indigenous patient events (OTN, 2018 [38]). The convenience of accessing health care services in one's own home can also make a difference for more sensitive types of care.…”