Telehealth for primary and preventive care among food-insecure individuals.

OBJECTIVES Using data from the 2020-2022 Medical Expenditure Panel Survey, we examined the relationship among food insecurity, access to a usual source of care, and telehealth utilization across 4 types of office-based and outpatient visits: general checkup, diagnosis or treatment, psychotherapy or mental health counseling, and follow-up or postoperative care.

STUDY DESIGN Retrospective analysis of nationally representative data.

METHODS The study employed logistic regression models for access to care, Poisson models for annual visit counts, and 2-stage Heckman selection models for telehealth utilization and associated expenditures.

RESULTS Food-insecure individuals had a 7.2% lower rate of annual visits (in-person and telehealth combined) than their food-secure counterparts. Food insecurity was associated with a 1.7-percentage point increase in the share of telehealth visits. Among individuals with a usual source of care, food insecurity was linked to higher telehealth use as travel time increased: 2.6 percentage points higher with 15 to 30 minutes of travel time, and 4 percentage points higher for travel times exceeding 30 minutes. Additionally, each 1-percentage point increase in telehealth share corresponded to a $117.64 reduction in health care expenditures per visit.

CONCLUSIONS These findings highlight significant disparities in health care utilization based on food security status in the US. Even after accounting for geographic access, food insecurity remains strongly associated with reduced health care use. It is important to test whether integrating food insecurity screening in health care settings and developing hybrid telehealth models (eg, mobile clinics) may help close gaps in access and improve outcomes for food-insecure populations.