As the COVID-19 pandemic disrupted in-person medical care, emergency regulatory changes
were implemented to promote use of telehealth,
1
moving this previously peripheral practice to the center of health care delivery in
the USA. One study of private health care claims found that telemedicine claims were
4000% higher in March 2020 than in March 2019.
2
Information on use of telehealth by patients can inform post-pandemic policy.
METHODS
The American Life Panel (ALP) is based on a probability-based representative sample
of the US adult population age 20 and over who are provided with internet-connected
devices and paid for survey participation. Data in this study come from the ALP Survey
on Impacts of COVID-19, which was fielded between May 1 and 6, 2020. Two thousand
fifty-two of the 2622 sampled panel members completed the survey (78% participation
rate).
3
Respondents were asked if they were receiving treatment for a chronic physical or
behavioral health condition when the pandemic began or if they considered seeking
care for a new or recurring condition during the pandemic. For each condition type,
respondents were asked about phone or video telehealth use due to the pandemic. Analyses
used sampling weights to account for non-response and match sample demographics to
the US population.
4
Study procedures were approved by the RAND IRB.
RESULTS
The sample of 2052 was, after weighting, 51.9% female, almost equally divided by age
group (20–39, 40–59, and 60 and older), and 63.9% white, with 94.2% insured. When
the pandemic began, 39.3% were being treated for a chronic physical health condition,
15.0% for a behavioral health condition; since the pandemic started, 16% had considered
seeking care for a new or recurrent condition. Almost half (48%) of these patients
used telehealth: from 43.2% (95% CI 37.9–48.5%) for physical conditions to 53.6% (95
CI 43.2–64.0%) for behavioral conditions (Fig. 1). Use of video was less common for
physical health care (13.7%, 95% CI 10.5–16.8%) than for behavioral health care (30.4%,
95% CI 20.0–40.7%). The vast majority of patients using telehealth saw their own doctor.
Fig. 1
Prevalence of telehealth use by condition, modality, and own doctor. Data are from
the American Life Panel Survey on Impacts of COVID-19.
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Proportions of patients who used telehealth are shown above bars. Proportions of telehealth
users who saw their own doctor are shown within bars.
Use of telehealth for behavioral health conditions was lower in females relative to
males, those 60 and over relative to younger ages, non-Hispanic Whites relative to
non-Hispanic Blacks, and those with less than a high school education relative to
those with a college degree (Table 1). Lack of insurance was associated with lower
telehealth use for new conditions (OR = 0.2, 95% CI 0.0–0.7). Use of telehealth was
more common in the Northeast than other regions.
Table 1
Predictors of Telehealth Use by Condition
Respondent characteristics
Conditions being treated when the pandemic began
New or recurrent condition
Any condition
Chronic physical condition
Behavioral health condition
Any pre-COVID-19 treatment
Odds ratio
95% CI
Odds ratio
95% CI
Odds ratio
95% CI
Odds ratio
95% CI
Odds ratio
95% CI
Sex (vs. male)
Female
1.1
(0.7–1.6)
0.4
(0.2–0.9)
0.9
(0.6–1.4)
0.8
(0.3–1.8)
1.0
(0.6–1.4)
Age (vs. 60 and over)
Ages 20–39
0.7
(0.3–2.0)
3.3
(1.4–8.1)
1.2
(0.6–2.4)
1.2
(0.5–3.2)
1.4
(0.7–2.6)
Ages 40–59
1.2
(0.8–1.8)
3.7
(1.7–7.9)
1.3
(0.9–2.0)
1.1
(0.6–2.6)
1.5
(1.0–2.2)
Race/ethnicity (vs. NH-White)
Hispanic
1.2
(0.6–2.6)
0.5
(0.2–1.8)
1.0
(0.5–2.0)
0.8
(0.3–2.3)
0.9
(0.5–1.6)
NH-Black
1.5
(0.8–2.8)
3.7
(1.1–13.1)
1.4
(0.8–2.6)
1.6
(0.4–6.3)
1.3
(0.7–2.3)
NH-Other
1.3
(0.5–3.4)
2.0
(0.5–9.0)
1.5
(0.7–3.5)
0.7
(0.2–2.8)
1.2
(0.6–2.6)
Region (vs. Northeast)
Midwest
0.5
(0.3–0.9)
0.4
(0.1–1.0)
0.4
(0.2–0.7)
0.5
(0.1–1.7)
0.4
(0.2–0.7)
South
0.5
(0.3–0.9)
0.6
(0.2–1.4)
0.5
(0.3–0.8)
0.8
(0.3–2.7)
0.6
(0.3–0.9)
West
0.4
(0.3–0.8)
0.3
(0.1–1.0)
0.3
(0.2–0.6)
0.6
(0.2–2.0)
0.4
(0.2–0.6)
Education (vs. college degree)
Less than HS
0.7
(0.3–1.9)
0.1
(0.0–0.6)
0.5
(0.2–1.2)
0.5
(0.1–3.4)
0.5
(0.2–1.2)
HS to Assoc
1.0
(0.7–1.5)
0.6
(0.3–1.2)
0.8
(0.5–1.1)
1.1
(0.5–2.2)
0.9
(0.6–1.3)
Health insurance (vs. insured)
Uninsured
1.1
(0.3–3.8)
0.4
(0.1–2.0)
0.8
(0.3–2.1)
0.2
(0.0–0.7)
0.5
(0.2–1.3)
Italicized entries indicate statistically significant associations at p = 0.05; NH,
non-Hispanic; HS, high school; Assoc, associate’s degree
Telehealth defined as a visit with a health care provider by phone or video connection
DISCUSSION
Despite evidence of its effectiveness,
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telehealth has remained at periphery of US healthcare. Between mid-March and early
May 2020, telehealth was used by over 40% of patients with a chronic physical health
condition (including almost 14% having done so by video) and over 50% of those with
a behavioral health condition (30% by video) or seeking care for a new health condition
(21% by video). A 2019 ALP study found that less than 4% of Americans had a video
telehealth visit in the past year
6
.
This shift to telehealth, particularly video, was enabled by time-limited, regulatory
changes related to reimbursement, privacy standards for telehealth technology, and
licensure. Lessons from utilization during this period can inform policy for the post-COVID-19
era. Three results from this national survey of patients have notable policy implications.
First, the dramatic increase in telehealth use was driven by patients seeing their
own doctors. The ability to see one’s own doctor may be a particularly challenging
feature to preserve once in-person care resumes. Second, telehealth was more likely
to be used for behavioral than for physical conditions; prospects for an expanded
role for telehealth may be better for behavioral health care. Third, measures will
be needed to ensure equity of access, particularly for behavioral health care where
education, age, and gender were all associated with use. Lack of health insurance
may affect telehealth use.
It is important to note that changes since early May would not be reflected in these
results. Analyses by specific medical conditions would add policy-relevant detail.
Post-COVID-19 policies will determine whether telehealth remains central to US health
care or returns to the periphery. Decisions should be informed by information about
how patients used telehealth during the crisis.