There are several significant challenges to ensuring equitable access to telehealth, especially for underserved groups. Policymakers and healthcare providers must take a multifaceted approach to overcoming these barriers.
One of the most immediate barriers is the digital divide in access to broadband internet and technologies like smartphones, laptops, and tablets needed to utilize telehealth services. According to the FCC, an estimated 21.3 million Americans still lack access to fixed broadband service at threshold speeds. Those without home internet access are disproportionately low-income individuals, residents of tribal lands, people of color, older adults, and those living in rural areas.
Policymakers should increase funding and incentives for expanding high-speed broadband infrastructure, especially in underserved rural and tribal communities. The recently passed Infrastructure Investment and Jobs Act allocates $65 billion toward expanding broadband access across the country. Providers can work with community groups and patients to distribute free or low-cost tablets and mobile hotspots in areas without home internet access.
Lack of digital literacy remains a substantial barrier, as many individuals may not have the technical skills to operate telehealth platforms. Both policymakers and providers need to invest in digital skills training programs, offered either in-person or virtually, to help underserved groups learn how to use technologies like videoconferencing applications and patient portals. Community organizations like libraries can partner with healthcare entities to provide digital literacy classes and one-on-one technology assistance.
The affordability of Telehealth services and connectivity is another hurdle. While the infrastructure bill and some state policies have expanded access to affordable broadband internet plans for low-income households, data plans and connectivity costs can still prohibit regular telehealth use. Policymakers should consider expanding federal subsidy programs for health-related connectivity and mandate that telehealth services have no to low patient cost-sharing. Healthcare providers also need to offer flexible payment plans or work with community clinics to provide free telehealth access points for the uninsured.
Language and cultural barriers also marginalize many groups from equitable telehealth care. Both medical interpreters and culturally-competent health education materials must be made universally available. Policymakers should require and provider reimbursement programs should cover 24/7 access to qualified medical interpreters across all major languages, including ASL interpreters for deaf individuals. Healthcare entities must translate all telehealth informational materials and platforms into prevalent non-English languages and ensure culturally-tailored health messaging.
Privacy and security concerns could disproportionately deter underserved patients from engaging in telehealth. Policies like HIPAA and the Federal Trade Commission’s Telehealth rule help protect patient data privacy and security during virtual visits. More needs to be done to foster trust, especially among vulnerable groups. Providers must communicate clearly how they safeguard personal health information, obtain explicit patient consent, and provide multi-lingual privacy training. When developing new technologies, inclusive user-experience design and community oversight can help address privacy, automation bias and surveillance risk for marginalized populations.
Lack of access to sufficient broadband-enabled devices remains a hurdle for many. Beyond expanding low-cost options, providers should consider lending medical-grade tablets and laptops pre-loaded with telehealth applications for patient use, especially for those managing chronic illnesses requiring frequent care. Mobile health clinics equipped with telehealth capabilities could also travel to underserved communities to increase access points.
A comprehensive approach is needed involving coordinated efforts between policymakers, healthcare systems, community partners and patients themselves. By addressing barriers related to infrastructure, affordability, language, literacy, privacy and access to enabling devices – especially in marginalized groups – telehealth’s promise of expanded access to equitable care can be more fully realized. Ongoing community involvement and cultural competence will also be key to overcoming historical mistrust and building resilient virtual care models for underserved populations.