Michelle Ma, The Bryn Mawr School, Baltimore, Maryland, USA
Since the start of the COVID-19 pandemic, more patients have been opting to receive medical care remotely from their homes. Telemedicine has seemingly proven to be an effective, efficient, and low-risk way for patients to access healthcare. However, the increasing popularity of telemedicine services have exposed socioeconomic and geographic disparities.
Though the proportion of telemedicine visits by black patients increased from 8.0% to 12.9% in the last year, a study conducted by the New York University Langone Health Center found that black patients were only 0.6 times as likely to have access to telemedicine care than white patients were (Chunara et al., 2020). The researchers also found that black patients were at an increased risk of diabetes and hypertension, which highlights the urgent need for complete telemedicine accessibility. Additionally, a separate study conducted on residents of Hidalgo County, Texas found that 28.6% of patients who received telemedicine care were non-Hispanic whites, compared to the 69% patients of Hispanic or Latino origin (Ramirez et al., 2020). However, given that 92.4% of residents in Hidalgo County are Hispanic and only 6% of residents are non-Hispanic white, the proportion of Hispanic patients using telemedicine visits is significantly lower (Ramirez et al., 2020). These findings are not exclusive in the communities where these studies took place; such disadvantages affect many Americans nationwide.
In addition, many geographical disadvantages are often overlooked, despite being another contributing factor to the lack of telemedicine equity that affects Americans in rural communities. In a study that analyzed the accessibility of telemedicine for users of Medicare, 41.4% of beneficiaries lacked access to a computer with high-speed internet at home, most of which lived in isolated rural areas (Roberts & Mehrotra, 2020). It is estimated that over 21 million Americans in total lack access to the internet, preventing them from using telemedicine services (Summers-Gabr, 2020). Consequently, many rural residents are unable to receive mental health care when needed, contributing to a higher percentage of people suffering from substance abuse and mental health problems in rural communities (Summers-Gabr, 2020). Given that rural counties generally have fewer psychologists and other mental health resources than urban counties, telemedicine would be the most accessible and convenient option for these areas (Summers-Gabr, 2020).
Similarly, one’s socioeconomic status also plays a significant role in their ability to receive telemedicine care. In the same study that analyzed the accessibility of resources for users of Medicare, it was found that while only 11.5% of those with an income above the national poverty level lacked adequate digital access, more than half of users with an income below the national poverty level did not have digital access at all. Medicare beneficiaries that completed a high school education at most, had a disability, or were Black or Hispanic were less likely to have digital access (Roberts & Mehrotra, 2020). Other factors, such as the unequal access to care, high illiteracy rates, and cultural responses to technological advancements in healthcare, may also be contributing to this difference. Without access to telemedicine, patients from these populations are unable to receive regular checkups, access to mental health resources, and much more.
Inequality of access to telemedicine is an ongoing issue that healthcare providers and policymakers nationwide are aiming to address. Many hospitals have begun redesigning their systems to accommodate those with lower socioeconomic statuses (Roberts & Mehrotra, 2020). In addition, under the Coronavirus Aid, Relief, and Economic Support (CARES) act, the United States Department of Agriculture (USDA) has received $100 million to fund its ReConnect program, which helps bring internet access to rural areas (Summers-Gabr, 2020). However, efforts to combat these disparities should not stop there. In order to ensure true health equity for all, we must acknowledge and prioritize the needs of those from vulnerable populations. Given the uncertain nature of the current COVID-19 pandemic and the inevitability of future pandemics, telemedicine may become more widely used amongst doctors, patients, and other healthcare providers. Therefore, we must strive to make tele-health services readily accessible for all individuals, regardless of sex, age, socioeconomic status, or race.
References
Chunara, R., Zhao, Y., Chen, J., Lawrence, K., Testa, P. A., Nov, O., & Mann, D. M. (2020). Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19. Journal of the American Medical Informatics Association, 28(1), 33–41. https://doi.org/10.1093/jamia/ocaa217
Ramirez, A. V., Ojeaga, M., Espinoza, V., Hensler, B., & Honrubia, V. (2020). Telemedicine in Minority and Socioeconomically Disadvantaged Communities Amidst COVID-19 Pandemic. Otolaryngology–Head and Neck Surgery, 164(1), 91–92. https://doi.org/10.1177/0194599820947667
ReConnect Program Overview. (n.d.). United States Department of Agriculture. Retrieved September 10, 2021, from https://www.usda.gov/reconnect/program-overview
Roberts, E. T., & Mehrotra, A. (2020). Assessment of Disparities in Digital Access Among Medicare Beneficiaries and Implications for Telemedicine. JAMA Internal Medicine, 180(10), 1386. https://doi.org/10.1001/jamainternmed.2020.2666
Summers-Gabr, N. M. (2020). Rural–urban mental health disparities in the United States during COVID-19. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S222–S224. https://doi.org/10.1037/tra0000871
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Telemedicine Consult. (n.d.). [Photograph]. https://upload.wikimedia.org/wikipedia/commons/7/7c/Telemedicine_Consult.jpg