The Pandemic of Health Care Inequity

“While telehealth is often used as an umbrella term for all patient care conducted by phone or audiovisual technology, it is important to note that these 2 methods have very different implications. For example, the Centers for Medicare & Medicaid Services specifies that “the provider must use an interactive audio and video telecommunications system” to conduct a virtual visit. We do not have to look far for an example of the inequity encoded by this strict definition. Recently, a patient under our care was denied home health services because his telephone visit with his primary physician did not qualify as a face-to-face encounter. Unable to leave his house easily—or safely, as rates of coronavirus disease 2019 (COVID-19) are still not suppressed in our area—and unequipped with the technology for a telemedicine visit as defined by his insurer, he was prevented from accessing the same care available to his neighbor with an internet connection. Beyond implications related to reimbursement, there may be qualitative differences between care provided over the telephone and that conducted via audiovisual technology. For example, patients with limited English proficiency have been shown to have worse understanding of diagnoses when interpretation was facilitated by audio alone compared with using video technology. More research comparing the content and quality of audiovisual to telephone-only visits is needed. Although we acknowledge the potential of telemedicine for many patients, we are concerned by the systematic introduction of a new mechanism of health inequity.”

Full article, Thronson RL, Jackson SL, and Chew LD. JAMA Network Open 2020.10.2