Does Telemedicine Transcend Disparities or Create a Digital Divide? Evidence from the COVID-19 Pandemic

We examine telemedicine utilization during the COVID-19 pandemic. Advocates have argued that telemedicine can overcome barriers in accessing healthcare and protect patients from contracting COVID-19. Rural and poor patients, for example, would not need to make expensive and time-consuming trips to healthcare facilities when using telemedicine. Conversely, telemedicine adoption may depend on broadband access and technology skills, which could create a digital divide and exacerbate disparities. We study these questions using data on virtual and conventional care from a large commercial insurer. Telemedicine utilization soared during the pandemic. We further find that telemedicine utilization was concentrated in urban and affluent markets. We attribute this to two factors. First, telemedicine use was correlated with broadband penetration. Second, telemedicine adoption was much higher for patients with an established healthcare provider relationship (i.e., received care in the same health system in the previous year). We also find that telemedicine utilization was lower among older patients and comorbidities; cohorts with the greatest risk of severe illness and death from COVID-19. Without further intervention, telemedicine could exacerbate existing health care disparities.