An extensive study of older Americans on Medicare found that widespread adoption of telehealth services has not led to more overall medical visits.
In many medical fields, the number of visits either stayed the same or declined. Telehealth primarily replaced face-to-face appointments instead of creating extra demand.
The issue has come to the fore because United States lawmakers must decide whether to continue supporting telehealth under Medicare.
Why the Study Matters
The research study was carried out by experts at the University of Michigan’s Institute for Healthcare Policy and Innovation and published in Health Affairs Scholar.
The size of the study makes it hard to ignore. The researchers examined every outpatient doctor visit billed to Medicare between January 2019 and June 2024.
That included data from over 60 million people aged 65 and older and more than half a billion medical visits. Studies this expansive are rare, which makes the findings hard to dismiss.
The goal was to find out whether telehealth access caused people to see doctors more often or whether it simply changed how care was delivered.
It was important to figure out because if telehealth leads to more overall visits, it could increase the cost of healthcare. If it doesn’t, then telehealth could be a way to improve access to quality care without adding pressure to an already strained healthcare system.
To answer the question, the team compared visit patterns from before the COVID-19 pandemic with patterns after telehealth became more widely available. They paid close attention to how different medical professionals used virtual care.
How the US Compares to Australia
The study challenged the assumption about how patients access healthcare services. It placed the US alongside countries such as Australia that have generated similar results.
The telehealth services in Australia featured on comparison website Medicompare have improved access to healthcare and not triggered unnecessary appointments.
During pandemic lockdowns, telehealth helped people retain access to primary care when face-to-face visits were difficult. But once restrictions eased, it didn’t lead to a surge in extra appointments.
The biggest growth was in mental health services, where telehealth made it much easier for people in rural and remote areas to get help.
The main problem wasn’t that too many patients were using telehealth – it was that there still weren’t enough doctors and healthcare workers to meet demand.
What separates Australia from the US is its decision to make many telehealth services permanent.
They still have to make certain adjustments, but that move has reduced uncertainty about whether virtual appointments will continue to be funded annually.
This reduced uncertainty about whether virtual appointments would continue to be funded.
How Telehealth Works Across Different Medical Specialties
Not all areas of medicine adopted telehealth in the same way. Some fields depend heavily on physical exams, scans or procedures, and have never fully moved online.
To understand how telehealth adoption affected overall use of care, the researchers grouped specialists into three categories based on how likely they were to use telehealth.
The first group included medical professionals who were mostly in surgical and procedural fields such as orthopaedics, ophthalmology, sports medicine and plastic surgery. Telehealth doesn’t play a huge role in these fields, so most healthcare still has to happen in person.
The second group included primary care and a wide range of medical subspecialties. That includes family doctors, internists, geriatricians, and specialists like endocrinologists and pulmonologists.
They used telehealth more often for check-ins, follow-ups or advice, but patients still needed to come in for face-to-face visits frequently.
The third group included behavioural health fields such as psychiatry and psychology. With their work based largely on conversations, they were able to use telehealth the most, and it worked effectively through video or phone.
Comparing these three groups gave researchers further insight into whether using more telehealth services led to more doctor visits overall or whether it just replaced in-person care.
Telehealth Usage Increased, but it Hasn’t Impacted Total Visits
Telehealth became a regular part of healthcare for people on Medicare during the post-pandemic period. Even medical fields that did not usually rely on telehealth moved some appointments online.
They moved more than five percent of visits online, and that figure rose to around 9% in primary care and medical specialties. In mental health care, nearly half of all visits were online.
However, even though telehealth was being used a lot, people were not having more appointments overall. The total number of doctor visits actually went down across every group.
In specialties that rarely used telehealth, total outpatient visits fell by around 14% compared with the pre-pandemic period. In the medium telehealth group, visits fell by 17%, while behavioural health dropped by 18%. This pattern was intriguing to researchers.
If telehealth encouraged patients to seek extra care, the opposite should have happened, especially in behavioural health. However, those specialties saw the largest declines.
