Do Telemedicine Payment Parity Legislations Matter?

Telehealth payment parity legislations were associated with improved rates of overall and video telehealth utilization during the COVID-19 pandemic.

In our article titled, “The Impact of Telemedicine Parity Requirements on Telehealth Utilization in the United States During the COVID-19 Pandemic,” we explore the literature on telehealth utilization, its barriers, and related legislations. Research has shown a dramatic increase in telehealth utilization during the COVID-19 pandemic as well as marked sociodemographic disparities in telehealth utilization. For example, Blacks, Hispanics, Asians, and American Indians/Alaska Natives (AIANs) were less likely to use telehealth services during the pandemic. Previous studies have shown conflicting findings on the association between the state’s telehealth payment parity laws and telehealth utilization, and there is a lack of differential impact studies by subgroups.

To address the gap, we examined the association between parity payment laws and overall, video, and phone telehealth utilization and related disparities by race and ethnicity during the pandemic by analyzing the US Census Bureau’s Household Pulse Survey (HPS) during the pandemic from April 2021 through August 2022.

WHAT DID WE FIND?

We found that adults in parity states had higher rates of overall and video telehealth utilization than their counterparts in non-parity states. In particular, non-Hispanic Whites and non-Hispanic Blacks in parity states had higher rates of telehealth utilization compared to those in non-parity states. Hispanics, non-Hispanic Asians, and non-Hispanic other races did not show a significant effect of parity act on overall telehealth utilization.

• The odds of overall telehealth utilization were 23% higher for adults in parity states than for those in non-parity states; the odds were 124% higher for video telehealth in parity states than in non-parity states.
• In parity states, non-Hispanic White adults had 24% higher and non-Hispanic Blacks had 31% higher odds of overall telehealth utilization than their counterparts in non-parity states.
• Non-Hispanic Whites had 143% higher odds of video telehealth utilization, while non-Hispanic Blacks had 77% times higher odds of video utilization in parity states.
• Only non-Hispanic Blacks in parity states had 60% higher odds of phone telehealth utilization than their counterparts in non-parity states.

WHAT POLICY IMPLICATIONS WE HAVE?

• Greater needs for using telehealth services among non-Hispanic Blacks might be a window of opportunity to implement telehealth policies to address Black-White disparities in access to health care.
• Given that an important barrier to telehealth use among Asians and Hispanics is limited English proficiency, linguistically appropriate care is essential to addressing racial and ethnic disparities in telehealth access.
• Future studies need to examine the effect of terminating parity payment laws after the public health emergency on access to care and health outcomes.

To learn more, read our research report, “The Impact of Telemedicine Parity Requirements on Telehealth Utilization in the United States During the COVID-19 Pandemic,” in the July 2023 issue of the JPHMP.

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Hyunjung Lee, PhD, is a principal scientist in the Cancer Disparity Research team within the Surveillance and Health Equity Science (SHES) department at the American Cancer Society (ACS) and a visiting fellow at Department of Public Policy and Public Affairs, John McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston. Her research focuses on social and behavioral determinants of health disparities among vulnerable populations. She particularly focuses on social and environmental conditions that can be changed through policy action.

Gopal K. Singh, PhD, is a career federal scientist with over three decades of experience in public health research. He has published four books and more than 200 peer-reviewed articles in the field of health inequalities, population health, health equity, social determinants of health, maternal and child health, and cancer and cardiovascular epidemiology.