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Health & Medicine

Telehealth Equity: Closing the Gap In Access to Healthcare

— December 13, 2023

Telehealth has become more accessible to underserved communities, reducing the strain on the smaller hospitals and clinics in these remote areas.

In a world where more than half of the global population still lacks access to essential health services, telehealth has emerged to bridge the gap. It opens the possibility of healthcare for all, changing the landscape of modern medicine. 

This article explores the reasons behind healthcare disparities, how telehealth benefits everyone, barriers to access, and the legal challenges of the system. Let’s get started.

Understanding healthcare disparities 

Healthcare disparities are differences in health and healthcare closely linked with social, economic, and environmental disadvantages. These may be influenced by factors such as: 

Social factors: Race, ethnicity, and religion often play a significant role in healthcare disparities. For instance, racial and ethnic minorities may face barriers to healthcare access due to discrimination, language barriers, or cultural misunderstandings. Similarly, religious beliefs can influence healthcare-seeking behavior and treatment decisions, potentially leading to differential health outcomes. 

Socioeconomic status: This includes income, education, and occupation, which is another key determinant of health disparities. Those with lower socioeconomic status often have less access to high-quality healthcare services, and they may also lack the resources to afford necessary medications or treatments. Additionally, they might have jobs that don’t provide health insurance or live in areas with scarce good healthcare facilities. 

One example is the lack of access to healthcare by America’s Indigenous Peoples. According to one study, 21% of Indigenous Americans and Hawaiians did not have access to a primary care physician because they were uninsured, 60% were more likely to have a full-time worker in the household, and 15% did not see a healthcare provider because of the cost. 

Gender and sexual orientation: This can also influence health disparities. Women, for example, often face gender-specific health issues, such as reproductive health problems, that may not be adequately addressed in healthcare systems. The LGBTQ+ community also faces unique health challenges and may experience discrimination or stigma when seeking healthcare. 

Mental health: Disparities are another major concern. Individuals with mental health conditions often face significant barriers to accessing appropriate care, including stigma, lack of awareness, and inadequately trained healthcare providers. 

Where people live: This can also impact their health and access to care. Those in rural or remote areas often have fewer healthcare resources available, including fewer doctors and hospitals. They may also face transportation issues that make it harder to access care. More than 8 million Americans don’t have high-speed internet connections, with rural areas particularly hit hard. 

The benefits of telehealth  

When it comes to connecting with healthcare professionals, telehealth services have made it simple. Rather than needing to drive to your GP’s office for an appointment, you can now make one easily online with the possibility of including a video call option. While virtual examinations aren’t optimal for healthcare delivery, they may provide a stop-gap option for some patients until their next in-person appointment. 

Additionally, telehealth initiatives have introduced new technologies such as remotely-monitored cardiac devices like defibrillators and pacemakers. Other telehealth gap-closing innovations included applications like fall-alert bracelets on smart watches or general health monitoring applications like blood-sugar level checking applications interfacing with devices designed to test blood-sugar levels and submit a readout to an app via WiFi.

Doctor advising patient via laptop telemedicine; image by Master1305, via
Image by Master1305, via

Telehealth services have also removed some strain from the hospital emergency rooms. One hospital in Queensland, Australia, reported a 28% decrease in patients being admitted to the emergency and a 53% decrease in visits to the hospital’s emergency department following the implementation of telehealth.

Barriers to telehealth access 

Although telehealth has done plenty of good nationwide in bringing healthcare to previously under-served communities, there are still a few barriers to telehealth access standing in the way of full implementation of the possibilities of telehealth.

Lack of health insurance coverage among lower-income communities 

Despite telehealth’s introduction as a bridge between communities and patients and the doctors who serve them, there is still an astonishingly high number of Americans who are completely uninsured for their health. That means that, despite a telehealth ‘visit’ with a physician costing between $40 and $90, the price is still unattainable for those whose medical insurance provider refuses to cover or who are uninsured.

According to a study from KFF, the highest numbers of uninsured were represented by Asian Americans and African Americans, with 64% of respondents quoting the cost of coverage being too high as their reason for being uninsured.

Privacy concerns for patient data 

One of the advantages of telehealth for hospital administrators, doctors, and nurses has been access to patient data and information, often in one central portal or throughout an online portal accessible nationwide through a patient’s health card number. Health insurance companies may also have access to medical records. 

Unfortunately, many Americans still have concerns about the privacy of their data. They are reticent to submit information to any online telehealth system, with nearly 89 million people in the United States reporting incidents of health data breaches, up from 43 million last year, despite safeguards put in place by the Department of Health and Human Services.

Legal and regulatory challenges 

Despite telehealth being around for almost 20 years, its regulatory framework has had to catch up quickly in the last few years, particularly following the COVID-19 pandemic. Federal and state governments have regulated telehealth at their respective governmental levels differently. 

A critical legal step in assuring the deliverance of telehealth was the Interstate Medical Licensure Compact, or IMLC, which allows physicians in different states to practice telemedicine across state lines, along with a Special Purpose Telehealth License. 

Studies suggest that telemedicine services still needed a federal, standardized set of rules governing how telehealth services are administered to guarantee a standard of care across patient groups, regardless of location or socio-economic status.

Targeting underserved communities 

Many Indigenous, poor, and rurally located communities are underserved by the American healthcare system and its current delivery methods. Implementing telehealth services in underserved communities will only increase access to healthcare in these communities and result in better health outcomes overall. 

The use of Starlink internet services in these communities (or the aiding of the funding for this by the American Government) would be a huge first step in ensuring that all Americans have access to telehealth care that bridges the gap for those with poor internet connections, or a lack of adequate transportation to attend appointments in-person. 

Similarly, the adoption of House Resolution 2903, proposed in 2022, sought to bridge the gap between insurance providers and patients by expanding reimbursement coverage under Medicare and Medicaid to patients using telehealth services. 

For the low-income strata of American society, bills such as H.R. 2903 would grant greater access to necessary healthcare options for those unable to pay for regular doctor’s appointments or those with chronic conditions that require regular care.

Telehealth post-pandemic

COVID-19 brought about the need for a rapid adoption of telehealth services nationwide. An adoption for which the American government and healthcare system at large were not necessarily ready.

However, in the nearly five years post-pandemic, telehealth has become more accessible to underserved communities, reducing the strain on the smaller hospitals and clinics in these remote areas. Additionally, telehealth’s integration with mobile phone applications has allowed for remote monitoring of various health conditions, from diabetes to cardiac conditions.

In the future, more coverage is needed to reach those without easy access to the internet or a WiFi connection generally, and more coverage is needed under Medicare and Medicaid to provide telehealth as a more accessible, affordable option to the lowest-income Americans.

In addition, providing telehealth options to around 27.6 million uninsured Americans can only lead to more positive health outcomes nationwide.

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