EFFECTS OF TELEHEALTH DURING THE COVID-19 PANDEMIC: HETEROGENEOUS ADOPTION, HEALTHCARE UTILIZATION, AND PATIENT OUTCOMES

<p dir="ltr">The COVID-19 pandemic caused a rapid increase in telehealth utilization as healthcare providers sought to mitigate virus exposure. Telehealth emerged as a crucial tool for maintaining healthcare services, particularly for vulnerable patients. However, the adoption and usage of telehealth varied significantly among different healthcare providers and demographic groups. Moreover, despite the widespread availability of telehealth services resulting from increased hospital adoption, utilization declined significantly for specific disease categories as pandemic pressure eased.</p><p dir="ltr">The first chapter of this dissertation aims to estimate the impact of healthcare organizations' telehealth adoption on patient utilization over time and how this effect is influenced by pandemic severity, lockdown policies, patient demographics, and hospital attributes. We further seek to understand how the effect of the availability of telehealth services varies across patient demographics. We employ an instrumented difference-in-differences approach on Medical Claims (Dx) data, which covers 191 million in-person and online medical visits related to breast cancer and schizophrenia from January 2018 to November 2021. By examining the heterogeneous uptake, usage, and healthcare outcomes of telehealth among patients, we gain insights into the most valuable areas of telehealth application.</p><p dir="ltr">The second chapter utilizes Dx data in the breast cancer category provided by one of the largest healthcare data providers in the United States to estimate the impact of hospitals’ telehealth utilization on patient healthcare usage during the COVID-19 pandemic. This includes examining telehealth visits, in-person office visits, total visits, emergency room visits, and new patient diagnoses. Our empirical findings indicate that while the number of telehealth visits significantly increased during the pandemic in 2020, the total number of healthcare visits remained largely stable with the adoption of telehealth services. However, telehealth usage significantly reduced the likelihood of emergency room visits related to breast cancer, suggesting that telehealth provides more flexible options for established patients, thereby reducing the need for emergency care as the last resort for healthcare access. Conversely, we observed that telehealth utilization negatively impacted the number of new patients at the hospitals, potentially due to capacity constraints as resources were directed toward satisfying existing patients. By analyzing healthcare utilization among patients with access to telehealth, this chapter provides valuable managerial insights for the healthcare industry.</p><p dir="ltr">In summary, these findings highlight that while telehealth was rapidly adopted to address unprecedented challenges during the pandemic and played an essential role in sustaining care delivery -- especially for ongoing patient management -- its impact varied widely across patient groups, disease types, and healthcare settings. The expansion of telehealth improved access and continuity of care for many established patients and alleviated strain on emergency services, but also revealed limitations in reaching new patient populations and underscored persistent disparities in utilization. Collectively, this research demonstrates the importance of nuanced telehealth implementation strategies to maximize its benefits and ensure equitable healthcare delivery in both emergency and routine contexts.</p>