Increases in the use of telehealth during the coronavirus pandemic among people with private insurance has occurred mostly among those who are more affluent and those who live in metropolitan areas, according to a new RAND Corporation study.

Researchers say the findings raise concerns that the pandemic may be worsening existing disparities in overall health care utilization.

Overall, the study found there was a 20-fold increase in the rate of telemedicine utilization following the outset of the pandemic in March 2020. At the same time, the rate of office-based medical encounters declined by nearly 50% and was not fully offset by the increase in telemedicine.

The findings are published online by the American Journal of Preventive Medicine.

“This study expands our understanding about the growing use of telehealth as the pandemic progresses,” said Jonathan Cantor, lead author of the study and a policy researcher at RAND, a nonprofit research organization. “Given our findings, policymakers should consider increasing efforts to reach populations that are deferring in-office care and not replacing it with telehealth visits.”

The study analyzed insurance claims from more than 6 million people who had employer-based health insurance in 2019 and 2020. The group represented about 200 employers across all 50 U.S. states.

Researchers examined the number and types of medical care received by enrollees from January 2019 through July 2020.

The increase in telemedicine was greatest among patients in counties with low poverty levels (about 48 visits per 10,000 people versus 15 per 10,000 people in high-poverty areas) and among patients in metropolitan areas (about 50 visits per 10,000 people versus about 31 visits per 10,000 people in rural areas).

Adults were more likely to have a telehealth visit as compared to children aged 12 and younger (about 65 visits per 10,000 adults as compared to about 50 visits per 10,000 children).

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