JAMA Netw Open
Telehealth kept healthcare costs stable, but access gaps remain
Clinical Takeaway: Telehealth can be useful for routine outpatient care without substantially increasing overall spending. However, it may improve convenience for patients already connected to care more than it reaches those with longstanding access barriers.
Telemedicine grew rapidly during the COVID-19 pandemic after federal policy changes expanded coverage for virtual visits. Since then, policymakers have questioned if virtual care would improve access for underserved populations, and if easier access would fuel unnecessary visits and higher healthcare spending.
This study examined those questions by analyzing claims data from more than 3 million continuously insured adults between 2019 and 2023 across Medicare fee-for-service, Medicare Advantage, Medicaid, dual-eligible, and commercial insurance plans. The analysis included 120 million ambulatory visits and $178 billion in healthcare spending.
Overall, telemedicine adoption was not linked to changes in healthcare use or spending. The data showed that visits fell 2.4% and spending declined 0.5%, with slightly higher spending in rural and commercially insured groups and modestly lower spending in some urban and Medicaid populations. However, these differences did not reach statistical significance. After stratifying the results by insurance type, urban and rural regions, and social vulnerability, the study similarly found that none of these groups showed clear increases or decreases in visits or spending.
The results suggest that telemedicine largely substituted for existing care rather than adding substantial new utilization or accelerating already high healthcare costs. At the same time, the results temper expectations that telehealth alone would substantially improve access gaps or healthcare engagement among underserved populations.
“Our findings suggest neither prediction came true on a national scale,” said John Mafi, MD, associate professor-in-residence of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. “As telemedicine use grew, visits and spending in heavy users tracked closely with patterns in lighter users.”
The analysis included claims data from Medicare fee-for-service, Medicare Advantage, Medicaid dual-eligible, and commercially insured adults, but did not include uninsured populations. The authors also noted that telemedicine use may still evolve as pandemic-era policies continue to change before current Centers for Medicare & Medicaid Services flexibilities expire in 2027.
Source: Mafi JN. JAMA Netw Open. 2026 May 11. Telemedicine Use and Healthcare Utilization and Spending Across Multiple Payer Types