During the Covid-19 pandemic, many non-emergency routine care practices shuttered their offices in order to protect patients and help stifle the wave of infection surging in the US. This led to many offices offering telehealth appointments. Telehealth, also known as telemedicine, is a doctor’s appointment which takes place virtually over a smartphone, tablet, or computer and relies on internet access.1 Patients who had the technical know-how and access to technology were able to opt for telehealth appointments. However, a plurality of individuals found their access to care interrupted during the pandemic because offices were not yet equipped for telehealth. Telehealth holds great promise for patients living in rural areas by reducing patient wait-times and travel-times, yet it also requires stable internet access and access to private spaces. Beyond expansion of remote health services, investment in internet access for all Americans bridges the digital divide which exists across geographic location, income, race, and educational attainment.2 Although not without its flaws, the expansion of telehealth services during the Covid-19 pandemic demonstrates that virtual care delivery is an effective way to administer safe, routine care in a remote manner.
Expanding health equity means ensuring that every person has access to the care they need without regard to their socioeconomic status.3 Health equity as it applies to telehealth depends heavily on digital literacy (technical know-how) and technology infrastructure (access to reliable broadband internet). A 2021 study on the Census Bureau's Household Pulse Survey found disparities in use of video telehealth services compared to audio services across age, race, and educational attainment.4 Compared to audio services, video services may require stronger internet connectivity, as well as access to compatible technology, knowledge of operating the technology, and an understanding of privacy concerns. To address concerns related to internet access, in May 2022, President Biden enacted the “Internet for All” Initiative, with specific stipulations to provide skills training to low-income individuals and strengthen the broadband capabilities of rural communities.5 Loosening restrictions on telehealth services also expanded access to care for Americans across geography and income. 11 or more states have allowed federally qualified healthcare centers (FQHCs) and/or rural healthcare clinics (RHCs) to provide services via telehealth.6 Making telehealth more accessible to all Americans is an important aspect of health equity in the digital age.
As of May 11, 2023, Covid-19 is no longer considered a public health emergency. Fortunately, telehealth expansions allowed during the Covid-19 pandemic have been extended to December 31, 2024.7 While regulations on delivery of care in a remote format were relaxed during the pandemic, expansion of telehealth services in the distant future remains to be known. Telehealth greatly increases the flexibility of providers to see patients without risk of transmitting Covid-19. The expansion also allows medicare patients to receive telehealth services for behavioral/mental healthcare in a remote format. Additionally, during the Covid-19 pandemic, appointments were able to take place on smartphone apps outside of a protected health portal without facing federal penalties. Telehealth holds great potential for increasing access to healthcare, especially during the context of an infectious disease epidemic.
While expansion of telehealth coverage, and relaxing of licensing requirements expanded telehealth utilization, challenges remain. Remote appointments raise concerns for privacy and verification of patient identity. Additionally, it remains unclear if a virtual doctor’s appointment has the same effectiveness as a traditional in-person appointment, depending on the nature of the visit. While virtual visits may not replace in-person visits, telehealth can be a useful supplement to in-person visits by adding greater flexibility to healthcare delivery.
- Health Resources & Services Administration. What is telehealth?. What is telehealth? | Telehealth.HHS.gov. https://telehealth.hhs.gov/patients/understanding-telehealth
- Chakravorti, B. (2021, July 20). How to close the digital divide in the U.S. Harvard Business Review. https://hbr.org/2021/07/how-to-close-the-digital-divide-in-the-u-s
- Health Resources & Services Administration. Health equity in Telehealth. Health equity in telehealth | Telehealth.HHS.gov. https://telehealth.hhs.gov/providers/health-equity-in-telehealth
- Karimi, M., Lee, E. C., Couture, S. J., Gonzales, A., Grigorescu, V., Smith, S. R., De Lew, N., & Sommers, B. D. (2022, February 1). National Survey Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services. Department of Health and Human Services. https://aspe.hhs.gov/sites/default/files/documents/4e1853c0b4885112b2994680a58af9ed/telehealth-hps-ib.pdf
- U.S. Department of Commerce. (2022, May 13). Fact sheet: Biden-Harris Administration’s “internet for all” initiative: Bringing affordable, reliable high-speed internet to everyone in America. U.S. Department of Commerce. https://www.commerce.gov/news/fact-sheets/2022/05/fact-sheet-biden-harris-administrations-internet-all-initiative-bringing
- Guth M., & Hinton, E. (2021, March 17). State efforts to expand Medicaid Coverage & access to telehealth in response to COVID-19. KFF. https://www.kff.org/coronavirus-covid-19/issue-brief/state-efforts-to-expand-medicaid-coverage-access-to-telehealth-in-response-to-covid-19/
- Health Resources & Services Administration. (2023, May 11). Telehealth policy changes after the COVID-19 public health emergency. Telehealth policy changes after the COVID-19 public health emergency | Telehealth.HHS.gov. https://telehealth.hhs.gov/providers/telehealth-policy/policy-changes-after-the-covid-19-public-health-emergency#:~:text=The%20Consolidated%20Appropriations%20Act%20of,Medicaid%20Services%20(CMS)%20website