Despite Flaws, Telehealth Benefits Low-Income Californians

In the process of ensuring equity among in-state residents, the California Health Care Foundation (CHCF) described that low-income Californians experienced many benefits from telehealth and intend to continue receiving care virtually.

Following the onset of the COVID-19 pandemic in 2020, telehealth gained users and supporters at a fast pace. Although telehealth continues to appear highly resourceful and effective in many instances, many indicate that ensuring health equity is necessary.

This largely comes with various indications of telehealth disparities. Research from September 2022, for example, noted that patients with visual impairments often miss out on the benefits of telehealth, mainly due to the limited resources available to assist this population.

This latest report from CHCF detailed experiences of California residents with low incomes when using telehealth. To gauge patient perceptions, CHCF had NORC at the University of Chicago (NORC) recruit 73 patients for the study. This population was relatively diverse; 53 percent were female, 40 percent were male, and 7 percent were transgender or nonbinary.

However, all participants were from California, had annual household incomes beneath 200 percent of the federal poverty level, and participated in a telehealth appointment within a year prior to the interview.

After interviewing study participants to determine levels of comfort, satisfaction, and future interest in telehealth, researchers identified several themes.

The report noted that among the study population, telehealth led to increased access to care. This was largely due to the elimination of travel, which led to lower costs and limited transportation challenges.

“Well, of course, when I have my physical and then the cardiologist, I always see a person because she wants to listen to my heart and test me,” one study participant, an 84-year-old White woman from Riverside County, said in the report. “So I usually go in person… But for the convenience, I’d rather do the telehealth. It cuts a lot out of my activity, where I get out of breath. And, plus, my son is not available to take me. It has saved him a lot of trips and taking him away from his responsibilities and his home and work."

Meanwhile, patients indicated high levels of trust and limited communication struggles when using telehealth to connect with providers. Researchers also noted that people with limited English proficiency said it was easier to communicate with providers via telehealth.

Many patients involved in the study, however, reported connectivity gaps during visits. Interviews also indicated that there is a higher level of trust in video visits as opposed to those conducted through only audio, alongside limited discomfort with the technology used in video visits.

Furthermore, although patients would like to choose the channel through which future visits take place, many intend to continue using telehealth.

In response, researchers recommended that patients and providers accept telehealth as a new part of care while ensuring that patients have their say. Given that members of a low-income population noted intentions to prolong telehealth use, it would be beneficial for health systems continuing to invest in this type of care This should occur while allowing patients to choose the modality through which they receive care, noted the report.

CHCF also detailed the need to maintain investments and offerings surrounding interpretation services along with access to language-concordant providers. They also noted that telehealth design should support disabled and diverse patient populations while focusing on technical improvements.