The Impact of Telehealth on Healthcare Utilization, Health Behavior and Health Workforce Supply

Objective: Telehealth (or telemedicine) has become the new norm in the healthcare system, accelerated by the COVID-19 (coronavirus disease 2019) pandemic. To respond to the public health emergency, the U.S. federal and state governments as well as private health plans implemented temporary legislation modifications to promote telehealth use. This dissertation estimates the impact of telehealth payment parity, mandating equal payment rates for telehealth and in-person services, on health service utilization (Aim 1) and health behavior in adopting recommended care (Aim 2) among insured workers with chronic conditions. Additionally, this study extends to the emerging telehealth market in China, examining factors that influence physicians’ labor participation in the dual practice through the Direct-to-consumer (DTC) Telehealth platforms (Aim 3). 

Methods: In Aims 1 and 2, we use the Merative Commercial Claims and Encounters database (2019-2021) to apply a difference-in-differences (DiD) estimation, which leverages the exogenous regulatory change in payment parity across states to facilitate causal inference design. Aim 3 adopts a mixed-methods approach to explore physician participation in telehealth in China. 

Results: Findings from Aim 1 indicate that payment parity significantly increased telehealth and overall outpatient visits but did not significantly increase in-person visits. The policy effect is more pronounced among employers with self-funded plans, typically large employers. In Aim 2, payment parity significantly increased psychotherapy visits and reduced Emergency Department (E.D.) visits among those with mental health disorders but did not significantly affect preventative care and flu vaccination. Aim 3 revealed that factors including department size, professional title, region, and specialty were associated with physicians’ participation in DTC platform. While monetary incentives were modest, non-monetary benefits, such as enhanced work efficiency and patient resources, motivated physicians.

Conclusion and Significance: In conclusion, this dissertation highlights the significant impact of payment parity on telehealth utilization and recommended care in the U.S., particularly for mental health services. Additionally, it underscores the importance of non-monetary benefits motivating physician participation in online dual practice in China. These findings provide evidence for policymakers to develop and implement sustainable payment models and health workforce strategies that facilitate the integration of telehealth services into healthcare practices in global communities.