Race, Age, Language Barriers Fuel Telehealth Delivery Disparities

January 26, 2023 - The UCLA Latino Policy and Politics Institute conducted a study that shows healthcare disparities linked to telehealth use during the COVID-19 pandemic resulted from race, age, language, and technology access barriers.

Restrictions to in-person healthcare led many patients and providers to use telehealth services after the COVID-19 pandemic hit. According to the Centers for Disease Control and Prevention (CDC), 37 percent of adults said they used telehealth within a year before 2021.

Although telehealth has served as a valuable resource for many, the UCLA Latino Policy and Politics Institute found that issues, including language barriers and insufficient access to technology, often prevented many people from reaping telehealth's benefits.

Researchers used data from a Los Angeles County healthcare system for the study. They analyzed visits that took place between January and December 2020. They also surveyed 39 healthcare providers from seven health systems between August 2021 and April 2022.

Following this process, they concluded that the need to consider patient race, ethnicity, age, and language when implementing telehealth is vital.

The researchers found that compared to White healthcare providers, providers of color were more likely to report that patients' race and ethnicity impacted their telehealth use. They also observed that language barriers prevented Latino and Asian patients in Los Angeles from using telehealth and that older patients and those with limited technology access, especially in the Latino community, relied on family members to help them engage in telehealth.

Arturo Vargas Bustamante, PhD, a professor of health policy and management at the UCLA Fielding School of Public Health and director of faculty research at the Latino Policy and Politics Institute, noted that further efforts to improve telehealth implementation could lessen inequities that communities of color often battle in the long run.

“For patients who may avoid medical appointments because of scheduling, the loss of wages or transportation challenges, telehealth offers an option to receive health care without leaving their home or workplace,” said Bustamante in a press release. “Our study found that while language and technological barriers persist, a hybrid approach, combining in-person and telehealth visits, has the potential to improve both the patient and provider experience.”

The research also shows that the share of telehealth visits increased by about 40 percent after the stay-at-home order took place in California in March 2020. Telehealth appointments were more likely to take place via phone rather than video, although this varied by race. Further, researchers found that telehealth use for health enhancement processes, such as wellness services, continued even as in-person care returned to usual volumes.

The researchers suggest that health systems wanting to expand telehealth capabilities "invest in telehealth navigation support, design hybrid approaches that provide both telehealth and in-person services, address technological accessibility and digital literacy, and educate providers about the role of race and ethnicity in telehealth delivery."

The study joins a vast array of research showing that telehealth use varies across demographics and socioeconomic backgrounds. 

A study from July 2022 found that many thoracic cancer patients experienced disparities when using telehealth during the COVID-19 pandemic. The researchers reviewed patient data from a thoracic oncology division and considered factors such as age, sex, ethnicity, insurance coverage, and location of residency.

After finding that the percentage of successful telehealth visits barely exceeded half, they noted that patients who were Black, on Medicaid, or lived in a zip code with an elevated risk of cancer mortality had a lower chance of experiencing a successful telehealth visit.