Younger patients with higher incomes and education levels are still the top consumers of telehealth, pointing to potential access inequalities, according to Rock Health’s 2021 Digital Health Consumer Adoption Survey.

The survey, which this year asked nearly 8,000 U.S. adults about their experiences with digital health and telemedicine, found the most likely telehealth consumers were higher income, between the ages of 18 and 44, with advanced degrees and with chronic conditions.

Those who were least likely to have used telehealth before were adults over the age of 55, making less than $35,000 per year, those living in rural areas, people taking no prescriptions and the uninsured. The survey found 28% of respondents had never used telehealth before.

In both 2020 and 2021, 40% of those living in rural areas said they didn’t use telemedicine at all. Though most reported that their primary care providers had started offering telehealth services during the pandemic, it was at a lower rate than those in suburban or urban areas.

In 2021, 9% of rural respondents that had never used telemedicine said poor cellular or broadband connectivity was a barrier, compared with only 4% of respondents in non-rural areas.

However, non-white survey participants were more likely to use telehealth services: 70% of white respondents reported using telehealth in 2021, compared with 87% of Hawaiian Native and/or Pacific Islander participants, 79% of Black respondents, 79% of American Indian and/or Alaska Native respondents, 78% of Asian respondents and 73% of Hispanic participants.

Racial disparities in telehealth access have been a concern in the past, and the report’s authors note how the survey was conducted – in English through the internet – might have left out some groups that could struggle to use telemedicine. 

“However, our finding aligns with a 2020 Pew study which found Black, Hispanic and other non-white adults were more likely than white adults to use telemedicine,” the authors wrote. “The study suggests that systemic racism contributing to healthcare disparities raised the need for these services, particularly among Black patients, during the pandemic.”

Pivot to video

Outside of potential access disparities, Rock Health’s survey also found that the pandemic boosted the use of live video telehealth, but that modality might give way before other models – like asynchronous care – as more companies roll out their own virtual care platforms. 

The report noted that 51% of respondents had previously used live video telemedicine in 2021, which is eight percentage points higher than in 2020, and 19 points higher than in 2019.

“Physician adoption of live video telemedicine skyrocketed in 2020 so care delivery would not come to a screeching halt. And even with the return of in-person care, the majority of 2021 survey respondents reported that these offerings are still widely available through their PCP. So it’s not surprising that across 2020-2021, approximately two-thirds of respondents reported accessing live video telemedicine through their clinician, as opposed to through their insurance, employer or other service,” the report’s authors wrote.

Satisfied customers?

Patients were also less satisfied with telemedicine this year. In 2021, 43% reported greater satisfaction with live video telehealth compared with in-person care. Last year, 53% reported more satisfaction with live video telemedicine. 

Consumers are using telehealth for different reasons this year too, with the top reason being minor illnesses. Last year, they primarily accessed telemedicine for a medical emergency. The report’s authors note this is probably a better use of telehealth, but it may have impacted how satisfied patients felt with their care. 

“With more and varied telemedicine options available, we are moving from evaluating ‘telemedicine satisfaction’ as a monolith to understanding consumer preferences within specific contexts,” they wrote. “Just like in-person care, people will like (and dislike) telemedicine experiences based on a wide range of factors – the convenience and accessibility of the interaction, the ‘webside manner’ of the clinician, whether their need was fulfilled, cost, etc.”