HHS: Disparities in video telehealth use highlight key barriers to access

While telehealth use exploded during the pandemic, a new federal study found massive income disparities in video versus audio services.

Department of Health and Human Services’ Assistant Secretary for Planning and Evaluation (ASPE) released a survey Tuesday (PDF) on telehealth use rates from April to October of last year. The report urged more equitable access to telehealth so that disparities don’t become permanent.

The survey of 808,368 U.S. adults found that 1 in 4 respondents used telehealth over the previous month.

Overall, telehealth usage from April to October was below rates from 2020 at the onset of the pandemic but still far above pre-pandemic levels.

Telehealth rates were similar among many demographic subgroups as between 21% to 26.8% used the service, but use was lowest among the uninsured with 9.4% and young adults 18 to 24 with 17.6%.

However, there were major disparities between the use of audio and video telehealth services.

“Among telehealth users, the highest share of visits that utilized video services occurred among young adults ages 18 to 24 (72.5%), those earning at least $100,000 (68.8%), those with private insurance (65.9%) and White individuals (61.9%),” the ASPE study said.

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But video telehealth rates plummeted among those who don’t have a high school diploma (38.1%) and adults 65 and older (43.5%). Video rates were also low among Latinos (50.7%), Asians (51.3%) and African Americans (53.6%).

“Although research shows that video visits offer some additional benefits compared with telephone visits, they require more complex setup, video-enabled devices and broadband internet access, which may present barriers for older adults, lower income households and those with limited English proficiency,” ASPE said.

The Biden administration has made some steps to help overcome barriers to telehealth access, including allocating $1 billion in American Rescue Plan Act funding to health centers for projects that include telehealth.

Additional access to insurance coverage could also help, as lack of insurance was also a key barrier.

Congress and the federal government should keep in mind the need for more equitable access to telehealth soon.

“For example, considerations for the equitable future use of telehealth as a supplement or replacement for some in-person care need to consider patient-centered outcomes including patient preferences, content of services and frequency of visits, technology access and quality of care,” the ASPE report said.

Flexibilities for reimbursement of telehealth under Medicare are set to run out after the public health emergency, which was recently extended into April.

Congress will need to make some of the flexibilities permanent, and providers are pushing for lawmakers to include legislation to do so in an omnibus spending bill being crafted.