When telemedicine use exploded during the COVID-19 pandemic, it inspired both optimism and anxiety.

Many believed virtual healthcare could finally make medical care more accessible for people living in rural communities, underserved neighborhoods and other areas with physician shortages.

Critics worried something very different would happen. They thought that the convenience of virtual visits would encourage overuse of medical services and send healthcare costs soaring.

The findings challenge the idea that virtual healthcare inevitably leads patients to seek unnecessary care simply because it is easier and more convenient.

Neither scenario appears to have occurred, according to a major new UCLA-led study. Researchers found that the rapid expansion of telemedicine was not significantly associated with increased medical visits or higher healthcare spending across a wide range of insurance types and patient populations.

These findings may help calm concerns among lawmakers who are debating whether to continue the temporary telemedicine policies introduced during the pandemic.

The study was led by Dr. John N. Mafi, associate professor-in-residence in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, and senior author Dr. Katherine Kahn, a distinguished professor of medicine at UCLA and a senior natural scientist at RAND, a nonprofit, nonpartisan research organization that provides leaders with the information they need to make evidence-based decisions.

“Our findings suggest neither prediction came true on a national scale,” Dr. Mafi said in a press release. “As telemedicine use grew, visits and spending in heavy users tracked closely with patterns in lighter users. That is reassuring for anyone worried about ballooning costs, but more sobering for anyone hoping telemedicine would close longstanding gaps in access. At least so far, it looks more like a substitute for in-person care than a true expansion of it.”

Virtual care still depends on reliable internet access, digital literacy, technology availability and insurance coverage — barriers that continue to affect many vulnerable populations.

The study arrives at an important moment. During the pandemic, the Centers for Medicare & Medicaid Services dramatically loosened restrictions on telemedicine: It allowed payment parity between virtual and in-person visits, removed geographic barriers, and waived certain out-of-pocket costs. Those changes helped fuel an unprecedented surge in virtual care.

But many of those pandemic-era flexibilities are set to expire in 2027 unless Congress acts to extend them.

To better understand telemedicine's real-word impact, researchers analyzed multi-payer medical claims data from more than 3 million insured U.S. adults between January 2019 and October 2023. Participants included people with Medicare fee-for-service coverage, Medicare Advantage, Medicaid, dual Medicare-Medicaid eligibility and commercial insurance. The researchers examined approximately 120 million medical visits and more than $178 billion in healthcare spending.

The investigators compared regions with high telemedicine adoption to those with relatively low telemedicine use. They used a statistical approach called “difference-in-differences analysis,” which allowed them to compare healthcare utilization and spending before and after telemedicine expanded during the pandemic.

The results were surprisingly modest. Overall, areas with higher telemedicine adoption had 2.4 percent fewer visits and 0.5 percent lower spending. However, those differences were not statistically significant, meaning the changes could simply have occurred by chance. The same pattern held across multiple sub-groups.

The research showed that:

  • Urban residents showed slightly fewer visits and somewhat lower spending.
  • Rural residents had slightly higher utilization and spending.
  • Medicaid recipients, Medicare Advantage beneficiaries, commercially insured patients and socially vulnerable populations all showed small variations in healthcare use and spending, but none of the differences reached a level of statistical significance.

In other words, telemedicine did not appear to dramatically increase healthcare use or spending for any major patient group. The findings challenge the idea that virtual healthcare inevitably leads patients to seek unnecessary care simply because it is easier and more convenient.

At the same time, the study also tempers hopes that telemedicine alone will solve healthcare access inequities. That may be partly because virtual care still depends on reliable internet access, digital literacy, technology availability and insurance coverage — barriers that continue to affect many vulnerable populations.

Rather than creating a wave of new medical spending, virtual care may simply be offering patients another way to access the healthcare system they already use.

The researchers also acknowledged several limitations. Because the study relied on insurance claims data, it could not fully measure quality of care, patient satisfaction or clinical outcomes. The analysis also focused on insured individuals, so the findings may not fully apply to uninsured Americans.

Even so, the study offers one of the most comprehensive national looks yet at how telemedicine may be reshaping healthcare. Rather than creating a wave of new medical spending, virtual care may simply be offering patients another way to access the healthcare system they already use.

For now, telemedicine appears to function less as a disruptive force and more as a practical extension of traditional care. It's convenient, useful and increasingly normalized, but not necessarily transformative in the sweeping way many predicted.

The study is published in JAMA Network Open.