Disparities in telemedicine use among Native Hawaiian and Pacific Islander individuals insured through Medicaid

Anna M Morenz; Ashok Reddy; Amy Hsu; Anh Le; Edwin S Wong; Joshua M Liao

doi:10.1093/haschl/qxae057

Disparities in telemedicine use among Native Hawaiian and Pacific Islander individuals insured through Medicaid

Health Aff Sch. 2024 May 3;2(5):qxae057. doi: 10.1093/haschl/qxae057. eCollection 2024 May.

Authors

Anna M Morenz^{1

2}, Ashok Reddy^{1

2}, Amy Hsu^{1

2}, Anh Le^{1

2}, Edwin S Wong^{2

3}, Joshua M Liao^{2

4

5}

Affiliations

¹ Department of Medicine, University of Washington, Seattle, WA 98195, United States.
² Program on Policy Evaluation and Learning in the Pacific Northwest, University of Washington, Seattle, WA 98195, United States.
³ Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States.
⁴ Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States.
⁵ Program on Policy Evaluation and Learning, University of Texas Southwestern Medical Center, Dallas, TX, United States.

Abstract

States have implemented policy changes to increase access to telemedicine services for individuals receiving Medicaid benefits. Native Hawaiian and Pacific Islander (NHPI) individuals experienced disproportionate harms from COVID-19 and have long experienced disparities in health care access compared with other racial and ethnic groups, making the issue of telemedicine access particularly salient for NHPI individuals on Medicaid. Utilizing 100% 2020-2021 Medicaid claims, we compared trends in telemedicine use between NHPI and non-Hispanic White individuals on Medicaid in Washington State and conducted a decomposition analysis to identify drivers of underlying disparities. In both years, NHPI individuals were 38%-39% less likely to use any telemedicine than White individuals after adjusting for patient- and area-level characteristics. Decomposition analysis revealed that most of this difference was due to differential effects of characteristics, rather than group differences in characteristics. Namely, several characteristics that were associated with increased telemedicine use had more muted associations for NHPI vs White individuals, such as English as the primary spoken language and female sex. These findings suggest the presence of limited acceptability of or group-specific barriers to telemedicine for NHPI individuals, including potential discrimination in being offered telemedicine visits. These issues should be understood and mitigated through close collaboration between health care leaders and NHPI communities.

Keywords: health care access; health equity; racial disparities; telemedicine.