Telehealth's Promise and Limits: Trends and Disparities in Pediatric Preventive Care Access, 2021-2023

Background and Purpose:
The COVID-19 pandemic led to a rapid increase in telehealth use in pediatric healthcare, with the expectation that virtual care might help reduce existing disparities in access. However, it remains unclear how telehealth adoption has impacted gaps in access across racial/ethnic, geographic, and insurance subgroups. This study aimed to (1) quantify trends in pediatric telehealth utilization from 2021 to 2023, and (2) assess whether telehealth use was associated with improved access to preventive care, particularly among historically marginalized populations. We hypothesized that telehealth use would decline post-pandemic and that its benefits would be unevenly distributed, with disparities by race/ethnicity, metropolitan status, and insurance type.

Methods:
We conducted a repeated cross-sectional analysis of the 2021–2023 National Survey of Children’s Health (NSCH), pooling data for children ages 0–17 (N=154,567 valid cases). The analytic sample was nationally representative, with survey weights applied. Key measures included telehealth use in the past year, receipt of preventive care, race/ethnicity, metropolitan status, and insurance type. Logistic regression models examined associations between telehealth use and preventive care, adjusting for covariates and testing for subgroup disparities. Trends in telehealth utilization were assessed via crosstabs by survey year.

Results:
Telehealth utilization among children declined steadily over the study period, from 22.3% in 2021 to 18.5% in 2022 and 15.1% in 2023. Logistic regression revealed that telehealth use was not significantly associated with receipt of preventive care (B = -0.038, p = .293, Exp(B) = 0.963). However, significant disparities in preventive care access persisted by race (overall p < .001), Hispanic origin (B = 0.158, p < .001, Exp(B) = 1.171), metropolitan status (B = -0.516, p < .001, Exp(B) = 0.597), and insurance type (B = -0.078, p < .001, Exp(B) = 0.925). Notably, children in metropolitan areas had 40% lower odds of receiving preventive care compared to their rural peers, and White children had lower odds compared to other racial groups. The model’s high overall prediction accuracy (95.6%) was driven by the high prevalence of preventive care.

Conclusions and Implications:
Despite the promise of telehealth, its expansion during and after the pandemic did not translate into more equitable access to preventive care for children. Disparities by race/ethnicity, geography, and insurance type remain, and telehealth alone is insufficient to address these gaps. These findings underscore the need for social work leadership in advocating for policy reforms that go beyond technology adoption—such as Medicaid reimbursement parity, targeted outreach in urban and minority communities, and culturally responsive care models. Aligning social work science with policy and practice is essential for achieving transformative change and health equity. Future research should explore telehealth’s impact on other domains, such as mental health and chronic disease management, and identify strategies to ensure virtual care benefits all children and families.