What Explains Inequalities in Telehealth Utilization Among North Carolina Medicaid Beneficiaries?

Authors

Karen Swietek, Health Care Evaluation Department, NORC at the University of Chicago, Cambridge, Massachusetts, USA.
Kelley A. Jones, Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Janet Prvu Bettger, Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA.
Alexis French, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Gary Maslow, Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA.
Katherine S. Norman, Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Ashley D. Lake, Duke Physical Therapy Sports Medicine at the Center for Living, Duke Health, Durham, North Carolina, USA.
Marissa Carvalho, Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, USA.
Rushina Cholera, Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Salama S. Freed, Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA.
Yolande Pokam Tchuisseu, Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA.
Samantha Repka, Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA.
Rebecca G. Whitaker, Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA.

Document Type

Journal Article

Publication Date

5-10-2024

Journal

Telemedicine journal and e-health : the official journal of the American Telemedicine Association

DOI

10.1089/tmj.2023.0563

Keywords

Medicaid; chronic conditions; equity; telehealth

Abstract

Increased availability of telehealth can improve access to health care. However, there is evidence of persistent disparities in telehealth usage, as well as among people from minoritized racial and ethnic groups and rural residents. The objective of our work was to explore the degree to which disparities in telehealth use for behavioral health (BH) and musculoskeletal (MSK) related services during the COVID-19 pandemic are explained by observed beneficiary- and area-level characteristics. Using North Carolina Medicaid claims data of Medicaid beneficiaries with BH or MSK conditions, we apply nonlinear regression-based decomposition analysis-based models developed by Kitagawa, Oaxaca, and Blinder to determine which observed variables are associated with racial, ethnic, and rural inequalities in telehealth usage. In the BH cohort, we found statistically significant differences in telehealth usage by race in the adult population, and by race, Hispanic ethnicity, and rurality in the pediatric population. In the MSK cohort, we found significant inequities by Hispanic ethnicity and rurality among adults, and by race and rurality among children. Inequalities in telehealth use between groups were small, ranging from 0.7 percentage points between urban and rural adults with MSK conditions to 3.8 percentage points between white adults and people of color among those with BH conditions. Overall, we found that racial and ethnic inequalities in telehealth use are not well explained by the observed variables in our data. Rural disparities in telehealth use are better explained by observed variables, particularly area-level broadband internet use. For inequalities between rural and urban residents, our analysis provides observational evidence that infrastructure such as broadband internet access is an important driver of differences in telehealth use. For racial and ethnic inequalities, the pathways may be more complex and difficult to measure, particularly when relying on administrative data sources in place of more detailed data on individual-level socioeconomic factors.

APA Citation

Swietek, Karen; Jones, Kelley A.; Bettger, Janet Prvu; French, Alexis; Maslow, Gary; Norman, Katherine S.; Lake, Ashley D.; Carvalho, Marissa; Cholera, Rushina; Freed, Salama S.; Tchuisseu, Yolande Pokam; Repka, Samantha; and Whitaker, Rebecca G., "What Explains Inequalities in Telehealth Utilization Among North Carolina Medicaid Beneficiaries?" (2024). GW Authored Works. Paper 4950.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4950

Department

Health Policy and Management