Who Is (and Is Not) Receiving Telemedicine Care During the COVID-19 Pandemic

TLDR

The COVID‑19 pandemic has made telehealth the primary mode of patient‑provider interaction, raising concerns that it may deepen existing disparities in healthcare utilization. Using data from 6.8 million and 6.4 million employer‑based beneficiaries in 2020 and 2019, the authors compared unadjusted rates before and after March 13, 2020 and applied a difference‑in‑differences regression controlling for patient demographics and county‑level sociodemographic factors to quantify changes in telemedicine and office‑based care. Telemedicine use surged more than 20‑fold after March 13, 2020, while office‑based encounters fell nearly 50%; the increase was greatest in low‑poverty counties, metropolitan areas, and among adults compared to children.

Abstract

IntroductionThe COVID-19 pandemic has forced telehealth to be the primary means through which patients interact with their providers. There is a concern that the pandemic will exacerbate the existing disparities in overall healthcare utilization and telehealth utilization. Few national studies have examined the changes in telehealth use during the COVID-19 pandemic.MethodsData on 6.8 and 6.4 million employer-based health plan beneficiaries in 2020 and 2019, respectively, were collected in 2020. Unadjusted rates were compared both before and after the week of the declaration of the COVID-19 pandemic as a national emergency. Trends in weekly utilization were also examined using a difference-in-differences regression framework to quantify the changes in telemedicine and office-based care utilization while controlling for the patient's demographic and county-level sociodemographic measures. All analyses were conducted in 2020.ResultsMore than a 20-fold increase in the incidence of telemedicine utilization after March 13, 2020 was observed. Conversely, the incidence of office-based encounters declined by almost 50% and was not fully offset by the increase in telemedicine. The increase in telemedicine was greatest among patients in counties with low poverty levels (β=31.70, 95% CI=15.17, 48.23), among patients in metropolitan areas (β=40.60, 95% CI=30.86, 50.34), and among adults than among children aged 0–12 years (β=57.91, 95% CI=50.32, 65.49).ConclusionsThe COVID-19 pandemic has affected telehealth utilization disproportionately on the basis of patient age and both the county-level poverty rate and urbanicity.