How perceptions of telehealth incentives and barriers impact patient choice
Southfield, Michigan (March 26, 2024) - On March 8, 2024, I presented a poster titled, “How Perceptions of Telehealth Incentives and Barriers Impact Patient Choice,” at the Michigan Academy of Science, Arts, and Letters’ annual conference at Lawrence Technological University in Southfield, Michigan.
The project sought to analyze the push-and-pull factors that influence patients’ decisions to use telehealth over traditional modalities of health care. To start, I probed what factors determined respondents’ past use of telehealth. Based on the answer to that question, the survey asked respondents whether they would either use telehealth again or would be interested in utilizing online health care for the first time. This data was then used to understand which features of the telehealth process were most attractive and most concerning to the respondents.
Before trying to determine patterns in perceived benefits and concerns, I analyzed what factors were associated with past telehealth use using bivariate logistic regression models. These analyses allowed me to tease out the demographic groups most and least likely to have used telehealth in the past, and demonstrate those probabilities compared with all respondents. I arrived at four statistically significant conclusions:
- Respondents that knew someone who had used telehealth were over three times more likely to have used telehealth in the past than respondents that did not know someone else who had used telehealth.
- Respondents that owned a computer were twice as likely to have used telehealth in the past than respondents that did not own a computer.
- Respondents that subscribed to home internet service were twice as likely to have used telehealth in the past than respondents that did not have home internet service.
- Respondents over the age of 65 were half as likely to have used telehealth in the past, compared with other respondents of other ages.
Next, the survey asked about the perceived incentives for using telehealth explicitly, and how those incentives would impact patients’ choices.[1] Using several prompt options, respondents could indicate the degree to which each incentive impacted their decision to utilize telehealth in the future. The graph below illustrates those results.
Respondents could answer that these features had no impact on their decision to use telehealth, a minimal impact, a moderate impact, or a major impact. Some of these features had a larger impact on respondents’ choices than others. Roughly 2 in 5 respondents (40.7%) said that being able to schedule a same-day visit would have a major impact on their choice to use telehealth. One-third of respondents (33.4%) said that the ability to get a basic prescription or treatment plan would have a major impact on their choice. Following that, the features that respondents found most attractive were avoiding a commute to save money (30.8% reported that it had a major impact on their choice), taking less time off work (30.6%), and the affordability of telehealth options (30.3%).
Similar to the question about incentives, the survey also asked respondents to indicate their level of concern about a number of response options related to telehealth use.[2] Respondents could answer with not at all concerned, a little concerned, somewhat concerned, and very concerned. The question did not ask respondents to indicate how it would influence their choice to use telehealth in the future. Therefore, I decided to analyze how these different factors influenced respondents’ intentions to utilize telehealth in the future – specifically among those that had not previously used telehealth – using bivariate logistic regression models. This approach also let me assess respondents’ likelihoods of using telehealth in the future, by comparing respondents who said they were very concerned about an indicator with respondents who said they were not concerned at all.
I arrived at the following statistically significant conclusions:
- Respondents who were very concerned about the privacy of their information were half as likely to say that they would consider using telehealth, compared with respondents who were not at all concerned about the privacy of their information.
- Respondents who were very concerned about the potential for misdiagnoses or issues not being addressed were almost four times less likely to say that they would consider using telehealth, compared with respondents who were not at all concerned.
- Respondents who were very concerned about the quality of care meeting their expectations were half as likely to say that they would consider using telehealth, compared with respondents who were not at all concerned.
- Respondents who were very concerned about the ability to access the internet from their home were about half as likely to say that they would consider using telehealth, compared with respondents who were not at all concerned.
- Respondents who were very concerned about their familiarity with using a computer or the internet were almost four times less likely to say that they would consider using telehealth, compared with respondents who were not at all concerned.
Not all of these concerns translate well into policy recommendations. But from these analyses, one predominant theme stands out – the ability to access and use the internet is necessary for utilizing telehealth. Unfortunately, those who could benefit most from this modality of care are the least likely to have home internet access.
According to UNC’s Cecil G. Sheps Center for Health Services Research, 192 rural hospitals have either closed or stopped providing inpatient care since 2005 – making health care increasingly difficult for millions of Americans.[3] Without reliable internet access, computing devices, or sufficient digital literacy skills, these patients may have to travel considerable distances for care, which could affect many aspects of their lives.
This issue, and these findings, underscore the importance of states’ BEAD and Digital Equity programs. Expanding internet access, adoption, and usage could literally save lives.
[1] The exact question wording asked: “To what extent would these potential benefits impact your decision to use telehealth appointments or online monitoring tools instead of in-person visits for routine health care in the future?”
[2] The exact question wording asked: “Please rate your level of concern about the following aspects of using online health applications.”
