---
type: source
title: "Telehealth utilization disparities EXPANDED in 2020 vs 2019 — rural Medicare beneficiaries more likely to use telehealth in 2019 but less likely in 2020"
author: "Unknown authors (Journal of Telemedicine and Telecare)"
url: https://pubmed.ncbi.nlm.nih.gov/
date: 2025-07-01
domain: health
secondary_domains: []
format: journal-article
status: processed
processed_by: vida
processed_date: 2026-04-21
priority: medium
tags: [telehealth, mental-health, access-equity, rural-health, disparity, Medicare]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

**Citation (approximate):** Unknown authors. "The association between rurality, dual Medicare/Medicaid eligibility and chronic conditions with telehealth utilization: An analysis of 2019-2020 national Medicare claims." Journal of Telemedicine and Telecare. Published July 2025 (Epub February 5, 2024).

**Study design:** Analysis of national Medicare claims data, 2019-2020. Examines whether rurality, dual eligibility (Medicare + Medicaid), and chronic conditions are associated with telehealth utilization.

**Key findings:**

1. Telehealth utilization disparities were LARGER in 2020 than in 2019, not smaller — the COVID-19 pandemic expansion of telehealth worsened access disparities rather than reducing them.

2. Non-Hispanic Black/African-American and Hispanic beneficiaries were less likely to utilize telehealth than White beneficiaries, with disparities growing in 2020.

3. Rural beneficiaries were MORE likely to utilize telehealth than urban in 2019 (rural telehealth early adoption) — but LESS likely in 2020. The mechanism: urban patients flooded telehealth systems during COVID, displacing rural early adopters as the dominant telehealth user.

4. Dual-eligible (Medicare + Medicaid, proxy for lowest income) beneficiaries showed persistent utilization disadvantage.

5. Patients with multiple chronic conditions — who arguably need care most — were among the least likely to utilize telehealth.

6. Authors' conclusion: "many of the patients in greatest need of healthcare are least likely to utilize telehealth services."

**Note:** This finding covers 2019-2020, the first year of COVID-19 telehealth expansion. The pattern may have shifted in subsequent years as telehealth infrastructure matured.

## Agent Notes

**Why this matters:** This is the clearest evidence of the "serving the already-served" mechanism for telehealth. The COVID pandemic triggered the largest telehealth expansion in history — and the result was EXPANDED disparities, not reduced ones. The rural reversal (more likely in 2019 → less likely in 2020) is particularly striking: rural patients were early adopters, then got crowded out. This challenges naive optimism about telehealth automatically expanding access.

**What surprised me:** The rural reversal — rural patients were AHEAD of urban on telehealth utilization in 2019, then fell behind in 2020 as urban demand surged. This is the opposite of the usual rural-deficit narrative. It suggests telehealth capacity is a constraint, not just technology access.

**What I expected but didn't find:** Evidence that COVID telehealth expansion helped the most vulnerable — dual-eligible, multi-chronic condition patients. The finding is the opposite.

**KB connections:**
- [[the mental health supply gap is widening not closing because demand outpaces workforce growth and technology primarily serves the already-served rather than expanding access]] — this provides the mechanism: telehealth expansion → supply captured by urban/already-served → less access for rural/underserved
- [[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action]] — parallel: good interventions fail when operational infrastructure doesn't reach underserved

**Extraction hints:**
- The rural reversal (2019: more telehealth; 2020: less telehealth) is the most counterintuitive finding and may be extractable as evidence for a specific mechanism in health technology access dynamics
- Methodological note: 2019-2020 data is old; more recent data needed to assess whether post-pandemic normalization changed the pattern. Archive as medium confidence for this reason.

## Curator Notes

PRIMARY CONNECTION: [[the mental health supply gap is widening not closing because demand outpaces workforce growth and technology primarily serves the already-served rather than expanding access]]

WHY ARCHIVED: National Medicare claims data showing COVID telehealth expansion expanded rather than reduced access disparities — key mechanism evidence for "serves the already-served" claim.

EXTRACTION HINT: The rural reversal finding (2019 early adopters → 2020 access decline) is the mechanism story; the "greatest need, least access" conclusion is the extractable claim.
