Who Is (and Isn't) Receiving Telemedicine Care During the COVID-19 Pandemic

Published in: American Journal of Preventive Medicine (2021). doi: 10.1016/j.amepre.2021.01.030

Posted on RAND.org on March 18, 2021

by Jonathan Cantor, Ryan K. McBain, Megan F. Pera, Dena M. Bravata, Christopher M. Whaley

Read More

Access further information on this document at Elsevier Inc

This article was published outside of RAND. The full text of the article can be found at the link above.

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has forced telehealth to be the primary mechanism for patients to interact with their providers. There is a concern that the pandemic will exacerbate existing disparities in overall healthcare utilization and telehealth utilization. Few national studies have examined changes in telehealth use during the COVID-19 pandemic.

Methods

Data on 6.8 and 6.4 million employer-based health plan beneficiaries in 2020 and 2019 were collected in 2020. Unadjusted rates were compared both before and after the week of the declaration of COVID-19 pandemic as a national emergency. Trends in weekly utilization were also examined using a difference-in-differences regression framework to quantify 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.

Results

More than a 20-fold increase in the incidence of telemedicine utilization following March 13, 2020 was observed. Conversely, the incidence of office-based encounters declined 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 compared with children aged 0–12 years (β=57.91, 95% CI=50.32, 65.49).

Conclusions

The COVID-19 pandemic has affected telehealth utilization disproportionately based on patient age, and both county-level poverty rate and urbanicity.

Research conducted by

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.