Library: NAIC – Trends in telehealth and its implications for health disparities

Executive summary :

Health inequalities are under the microscope

The intersection of race and insurance is one of the four regulatory priorities of the National Association of Insurance Commissioners (NAIC) for 2022 and has been a key initiative of the NAIC since 2020.

One workstream of the initiative is devoted to measures to advance health equity through lowering the cost of healthcare and promoting access to care and insurance coverage for historically disadvantaged and marginalised groups.

A charge from the workstream to the NAIC’s Health Innovations Working Group (HIWG) is to examine the potential for telehealth to ameliorate (or exacerbate) health disparities, particularly for racial and ethnic minorities, but also the LGBT+ community and across the urban-rural continuum.

Demand for telehealth has grown

This review engages with the HIWG on that directive by documenting recent developments and trends in telehealth and implications for regulators and addressing implications for disparities in health and healthcare. Disparities in health outcomes and healthcare across disadvantaged and marginalised groups are well-documented. The substantial increase in the utilisation of telehealth during the COVID-19 pandemic has sparked considerable interest in telehealth, and along with that interest, questions about the implications for existing socioeconomic and demographic health disparities. We find the greatest potential for telehealth to reduce health disparities is by surmounting barriers in access to care.

Telehealth relies on broadband access

Unfortunately, the potential for telehealth technologies to increase parity in access to care and health outcomes is limited by access to broadband internet and digital literacy. We show marked disparities in broadband internet access across population groups, particularly in rural areas and among racial and ethnic minorities, especially Native Americans. Even with access to broadband, many in these same groups lack sufficient digital literacy to leverage digital technology to improve health. Older adults also are limited by digital literacy.

Our overall assessment is that limitations in broadband access and digital literacy likely will constrain efforts to increase access to care for disadvantaged and underserved Americans through telehealth. While digital inequities may not exacerbate existing socioeconomic and demographic health disparities, they may create a new one. Still, reducing disparities is a bottom-up effort to alleviate the burden of disease in disadvantaged populations.

Access to care improved by telehealth

Disparities could widen, but telehealth will improve access to care, and ostensibly, health outcomes, for some of the disadvantaged. We suggest that for telehealth to effectively bridge gaps in access to care, healthcare professionals and patients must have a reliable guarantee of coverage and parity. Further, to reach the critical mass of telehealth utilisation to make it cost-effective, sufficient infrastructure must be put in place and both providers and patients adequately trained. Finally, to be equitable, and indeed, to make significant progress in reducing gaps in access to care, technology and digital literacy must be better diffused across socioeconomic and demographic groups.

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