Disparities Common in Telehealth Use Among Pediatric CHIP Patients

While reviewing pediatric virtual care activity during the COVID-19 pandemic, data from Alabama’s standalone Children’s Health Insurance Program, ALL Kids, researchers found that telehealth use was less common among those living in rural areas and members of lower-income families.

Between March and December 2020, 106,478 patients enrolled in the ALL Kids program. Of these patients, 13.4 percent used telehealth, and 24.7 percent had no medical claims.

The number of patients with no medical claims rose from 19.5 percent and 20.7 percent in 2019 and 2018, respectively.

Researchers also noted that children living in large or small rural areas were less likely to use telehealth, with 11.8 and 11.1 percent of each population used virtual care services, respectively. This was lower than the 14.3 percent of urban residents who used telehealth.

Further, they found that younger patients aged 6 to 12 years used telehealth less than those aged 12 to 18 years. Of the 33,599 patients aged 6 to 12 years, 4,601 used telehealth services. Meanwhile, 6,119 of the 44,847 patients aged 12 to 18 years used virtual care.

Patients coming from lower-income families were also less likely to use telehealth services, with only 14.6 percent of patients whose family incomes were 209 percent to 317 percent of federal poverty levels using telehealth as compared with 11.2 percent among higher-income families. This was likely due to the barriers associated with access to technology, according to the study.

Regarding the type of provider that filed medical claims, general pediatrics and family practice physicians were the most common, followed by mental and behavioral health specialists. General pediatrics and mental health specialists accounted for 39.3 percent and 34.5 percent of services, respectively.

The digital divide and the limited availability of resources likely played a role in creating care gaps. Researchers acknowledged that as the presence of telehealth continues to grow, it is essential to continue to increase accessibility and eliminate disparities.

Researchers also noted the limitations of the study, including a lack of knowledge regarding the reason for low telehealth use and no medical claims.

During the COVID-19 pandemic, several studies shone a light on disparities in telehealth use and some suggested strategies for eliminating these gaps.  

A study from September 2020 found that Black patients were less likely to engage in telehealth services compared to White and Asian people. Published in the Journal of the American Informatics Association, the study showed a lack of access to virtual care among certain populations. Researchers also described how language and age were contributing factors to widening disparities.

Another study from January 2021 showed that patients in poorer health and not covered by public insurance were using telehealth less frequently. As telehealth has continued to grow during the pandemic, underserved populations with chronic illnesses continued to find their needs underserved.

In response to these healthcare disparities, the Jackson State University College of Health Sciences in Mississippi used a grant to create a Digital Telehealth Hub in September 2021. The goal is to address racial health disparities by conducting research, providing new technology, and applying solutions locally.