Demographic Differences in Telehealth Policy Outcomes

Demographic Differences in Telehealth Policy Outcomes

Mary Schmeida (The Cleveland Clinic, USA) and Ramona McNeal (University of Northern Iowa, USA)
DOI: 10.4018/978-1-60566-002-8.ch036
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This chapter is an analysis of demographic variables influencing policy outcomes with online health information searches in the general U.S. public. This study is based on The Internet and American Life Daily Tracking Survey, August 2006 from the Pew Research Center for the People and the Press. Multivariate regression statistical technique is used to explore changes in individual level behavior following the search for online medical information. The data show individuals in most need of healthcare services (poor, less educated, and minority groups) and those with a recent demand for services, are more likely to make changes to improve their health after accessing online medical information.
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The public sector in the U.S. is increasingly using the Internet to provide information, deliver services, and interact with citizens, businesses, and other government agencies (West, 2003, 2004). There are numerous reasons for the government adoption of electronic government (e-government) practices that “refer to the delivery of information and services via the Internet or other digital means” (West, 2004, pp 2). E-government is expected to deliver services and information around the clock, making government more efficient and transparent to the public (Tolbert and Mossberger, 2006; West, 2003). The adoption of these practices may make government more responsive through its ability to provide communication options that are quicker and more convenient for users (Thomas and Streib, 2003).

Telehealth is an important example of e-government that takes on many forms. Although there is no consensus on its definition, the United States Congress defines telehealth as the use of electronic information and telecommunication technology to support long-distance clinical healthcare; patient and professional health-related education; public healthcare and administration (U.S. House of Representatives 2157, 2001). In practice, telehealth is understood as the inclusion of telemedicine plus other on-line social services.

Regardless of how telehealth is defined, this new medium for delivering medical services has been adopted with the goal to improve the accessibility of public and private healthcare, service quality and clinical outcomes. It is often implemented as a way to provide cost-effective healthcare. However, if we examine all the different aspects of telehealth in the U.S.—technology-enabled delivery, regulation and enabling legislation (state policies), and healthcare information available online, we find a unifying theme of broadening healthcare access. Telehealth practices may act to expand healthcare services through improving the dissemination of health information by Internet to the public, facilitating Internet based second opinions on disease management, improving consultative services to rural facilities and has the potential to reduce medical errors (Schmeida, 2005).

Despite the hopes for telehealth (as well as other forms of e-government), there is also a literature suggesting that these service delivery advancements will not live up to expectation. One barrier to the Internet for expanding healthcare access is the Internet cleavages that exist among United States citizens---people who do and do not use the Internet. These differences in Internet usage are based on a number of socioeconomic factors including age, income, education and race. The variation in Internet practices attributed to these socioeconomic factors has been linked to underlying inequalities in Internet access and technological skills, along with psychological barriers (Mossberger, Tolbert and Stansbury, 2003; Stanley, 2003). This suggests that e-government will only act to widen the gap between those that do and do not benefit from telehealth services.

Supporting this literature on Internet inequalities is research examining the differences in online health information searches among the various socioeconomic groups in the U.S. (Schmeida and McNeal, 2007). In exploring differences among socioeconomic groups in searching for Medicare and Medicaid information online, Schmeida and McNeal (2007; 2006) find some disparities are narrowing as the elderly and poor in need of these publicly subsidized health insurance programs are online searching for information at the U.S. Centers for Medicare & Medicaid Services Web site. Services and information obtainable at this Web site include eligibility criteria, enrollment procedures, Medicare plan options, local physicians and medical suppliers, pharmacy directory and healthcare chat rooms. In addition, beneficiaries can obtain personal information on their benefits and services. However, people without Internet access and experience, remain disadvantaged in accessing this critical information that can link them to needed healthcare services, suggesting that e-government service delivery advancements may not be living up to expectation.

Key Terms in this Chapter

Internet: A worldwide computer network that is capable of linking all network users.

Telehealth Policy: An electronic government policy that uses the Internet to improve accessibility of public and private and non-profit healthcare services in rural and urban areas, while improving the quality of services at lower service costs.

Electronic Government (e-Government): The delivery of information and services online through the Internet or other digital means (West, D.M., 2000; p. 2)

U.S. Internet Cleavages: Internet cleavages that exist among United States citizens---people who do and do not use the Internet, and can be based on a number of socioeconomic and psychological factors.

Telehealth: The term is often interchanged with telemedicine. There is no consensus on its definition. However, the United States Congress defines it as the use of electronic information and telecommunications technologies to support public health and health administration,long-distance clinical healthcare, patient and professional health-related education (H.R. 2157, 2001). An example of e-government.

Demographics: Population statistics about socioeconomic factors such as gender, age, education, income, marital status, ethnicity, etc.

Poisson Regression: A linear model, Poisson regression analysis is used when the response variable represents counts.

Technological Skill: Skills, such as being able to use a computer mouse and knowing how to find Internet information. Younger individuals are more likely to have developed these skills because of Internet exposure in school. A barrier to widespread e-government is lack of technological skill.

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