Telehealth for Prenatal Care: Heterogeneous Effects on Utilization and Birth Outcomes Across Racial Groups

• In Event: Maternal and Infant Health at the Crossroads: Interdisciplinary Evidence for Holistic Policy Solutions

Abstract

Maternal and infant health indicators in the U.S. rank amongst the lowest of developed countries. If we look at these indicators by race, the disparities are alarming with Black and American Indian women having more than two times worse outcomes than White women. Increasing access to high-quality prenatal care remains one of the main strategies proposed to improve these indicators. Using technology for prenatal care service delivery is a cost-saving alternative for both healthcare providers and pregnant women that can help increase access to prenatal care. Yet no research to date has explored the causal impact of telehealth healthcare services on maternal and infant health. We seek to fill this void.

To assess the impact of telehealth services on prenatal care utilization and birth outcomes, we take advantage of the expansions in telehealth services that occurred during the COVID-19 pandemic era. The COVID-19 pandemic challenged America’s traditional maternity care systems and shed light on the lack of proper access to care among some populations. Overall, people of color are more likely to be uninsured and face other barriers to care (Hill et al. 2023). At the same time, the pandemic led to unprecedented policy responses toward expanding access to health care, through expansions to health insurance and telehealth services (Dague and Ukert 2023). Acharya et al. (2023) show that prenatal telehealth visits increased by extensively during the early months of the COVID-19 pandemic. 

Using monthly individual-level data from the National Center for Health Statistics (NCHS) and taking advantage of the staggered implementation of telehealth expansions by state governments, we estimate a staggered difference-in-differences model using the Callaway and Sant’Anna (2021) estimator. We also test variation in outcomes amongst non-white patients. Preliminary results show that telehealth expansions increased prenatal care utilization by almost two visits, but access to telehealth only improves birth outcomes for fully treated pregnancies and does not translate into better outcomes for non-white pregnancies. The results of this work guide optimal policy arrangements for equitable healthcare outcomes that extend beyond the pandemic era.

Author

• Johabed G. Olvera, Pennsylvania State University
  Presenting Author