Healthcare Inaccessibility: Diagnostics and Digitization

By: Carissa Nair, Biological Sciences ‘26 

We live in an age of unprecedented scientific innovation. In recent years, there have been developments in detecting biomarkers for debilitating diseases, in creating algorithmic computational models to map disease progression, and in expanding patient-provider networks with AI and telehealth. Paradoxically, however, in this age of progress, development, and expansion, healthcare disparities and inaccessibility remain prevalent. While software like Telehealth was designed to advance accessibility, recent studies by researchers such as Phuong et al. suggest flaws in the support and fulfillment of such ventures that limit access for marginalized populations (1). Additionally, Lofters et al. conducted research that calls to attention barriers to life-saving diagnostic testing, such as cancer screenings, for immigrant and low-income populations (2). The transition between diagnostic healthcare research and its implementation in society, therefore, is one that involves important consequences for public health.

Telemedicine, through its integration of digitization and medical practice, has facilitated an increase in patient-provider connection and communication, especially during the pandemic. In a 2021 study, Haleem et al. detailed seventeen useful applications of telemedicine, one of which was improved access to medical care in remote regions (3). However, this innovation has not been entirely successful in its quest to uniformly bridge the accessibility barrier for all patient populations. The term IGI, or intervention-generated inequalities, refers to the potential of public health strategies and technologies to disproportionately benefit advantaged individuals (4). The implementation of telemedicine has the effect, in some cases, of exacerbating existing inequalities. For instance, in a 2022 study, Price and Simpson investigated how the use of features like “online patient portals” in telemedicine limited healthcare access to English-speakers with high digital literacy and access to the internet. The researchers found that racial minorities, older individuals, and low-income populations were less likely to use these portals (5). 

Furthermore, based on the results of a multi-dimensional study assessing text, in-person visit, and telemedicine usage by individuals in an oncology clinic, Tong et al. uncovered a trend of under-utilization of telemedical care in older and low-income populations, women, Native Americans, and uninsured individuals. That said, researchers determined that telemedicine could have the effect of exacerbating some of the demographic and socioeconomic disparities it was intended to address (6). Therefore, the results of studies such as these necessitate evaluation and re-design of existing telemedical systems, with the goal of reforming platforms of digital medicine to encompass more patient populations and provide higher quality care and attention.

The exacerbation of existing health care disparities, however, is not a consequence limited to the implementation of telemedicine. Routine diagnostic testing, such as cancer screenings, are not received/accessed uniformly by patients. In 2018, a study conducted by Fiscella et al. illustrated that minority and low-income populations are screened at lower rates than their affluent counterparts. They also delineated a few key problems associated with access to screening procedures, such as lack of insurance, financial and non-financial barriers, and the use of “low-intensity interventions,” such as an email, to remind patients about an upcoming visit — there are lower response rates among low-income individuals in the case of the latter (7). This inaccessibility is not restricted to cancer screenings, and unfortunately extends to the diagnosis of neurological disorders as well. The National Institute of Aging discovered that Black Americans were 35% less likely to receive an Alzheimer’s diagnosis as compared to white patients, based on the results of many compiled Alzheimer’s research studies. Given the fact that Black Americans are more at-risk for Alzheimer’s, dementia, and related conditions (8), this statistic is especially alarming.

Thus, studies addressing disparities that arise from telemedicine and diagnostic screening illustrate the importance of evaluating intent versus implementation. While both held the promise of improving accessibility to medical care, flaws in the design and distribution of these innovations have disproportionately benefit advantaged patient populations. As a result, it is crucial to continue to scrutinize, evaluate, and advance these programs and initiatives to ensure they fulfill their potential and help bridge the gap in the disparities that loom so large in the world of healthcare.

References

1. Phuong, J., Ordóñez, P., Cao, J., Moukheiber, M., Moukheiber, L., Caspi, A., Swenor, B. K., Naawu, D. K. N., & Mankoff, J. (2023). Telehealth and digital health innovations: A mixed landscape of access. PLOS digital health, 2(12), e0000401. https://doi.org/10.1371/journal.pdig.0000401

2. Lofters AK, Wu F, Frymire E, et al. Cancer Screening Disparities Before and After the COVID-19 Pandemic. JAMA Netw Open. 2023;6(11):e2343796. doi:10.1001/jamanetworkopen.2023.43796

3. Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors international, 2, 100117. https://doi.org/10.1016/j.sintl.2021.100117

4. Lorenc T, Petticrew M, Welch V, Tugwell P. What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health. 2013 Feb;67(2):190-3. doi: 10.1136/jech-2012-201257. Epub 2012 Aug 8. PMID: 22875078.

5. Price, J. C., & Simpson, D. C. (2022). Telemedicine and Health Disparities. Clinical liver disease, 19(4), 144–147. https://doi.org/10.1002/cld.1171

6. Tong, L., George, B., Crotty, B. H., Somai, M., Taylor, B. W., Osinski, K., & Luo, J. (2022). Telemedicine and health disparities: Association between patient characteristics and telemedicine, in-person, telephone and message-based care during the COVID-19 pandemic. IPEM-translation, 3, 100010. https://doi.org/10.1016/j.ipemt.2022.100010

7. Fiscella, K., Humiston, S., Hendren, S., Winters, P., Jean-Pierre, P., Idris, A., & Ford, P. (2011). Eliminating disparities in cancer screening and follow-up of abnormal results: what will it take?. Journal of health care for the poor and underserved, 22(1), 83–100. https://doi.org/10.1353/hpu.2011.0023

8. U.S. Department of Health and Human Services. (2021, December 16). Data shows racial disparities in alzheimer’s disease diagnosis between black and white research study participants. National Institute on Aging. https://www.nia.nih.gov/news/data-shows-racial-disparities-alzheimers-disease-diagnosis-between-black-and-white-research