Higher than expected telemedicine use by racial and ethnic minority and cognitively impaired Medicare beneficiaries.

Abstract

Although pandemic-era telemedicine flexibilities may have preserved access to care, concerns remain that telemedicine may have been inequitably distributed among older adults, especially those with mild cognitive impairment or dementia (MCID). As telemedicine flexibilities are set to fully expire on December 31, 2024, we aimed to examine pandemic-era and future-intended telemedicine use among older Americans to help inform post-pandemic telemedicine policy design. We hypothesized that telemedicine would be disproportionately underutilized among older adults with MCID or with racial and ethnic minority status. We used nationally representative survey data from the Health and Retirement Study and analyzed pandemic-era and future-intended telemedicine use among 10 075 Medicare beneficiaries aged >50 years during 2020-2022 by cognition across beneficiaries-level characteristics such as age, gender, insurance status, education, and multimorbidity. Results were adjusted by survey weights and nonresponse rates for national representativeness. Contrary to our hypothesis, compared with White Medicare beneficiaries, Hispanic and Black beneficiaries with normal cognition reported 44% and 57% greater pandemic-era and future-intended telemedicine use, respectively, while Black beneficiaries with MCID reported 57% greater pandemic-era telemedicine use. Our findings suggest that pandemic-era telemedicine utilization was especially common among racial and ethnic minority groups and those with MCID.