Book Summary:
This research is concerned with expanding access to healthcare. One method to do this is through use of new technology. Telehealth is the use of advanced communication technology to expand healthcare access. The policy aims to improve accessibility of public and private healthcare services in rural and urban areas, improve the quality of services, and reduce service costs. The varying chapters of this dissertation explore different phases of the policy process (policy adoption, policy implementation), as well as varying levels of analysis (state laws and program implementation versus individual behavior) to analyze barriers to the expansion of telehealth in the United States. Drawing on the growing literature in e-government and e-commerce, the research explores: (1)Â the scope of telehealth program implementation in the American states, (2)Â the adoption of enabling laws for telehealth, and (3)Â disparities in using online health information. Fifty-state multivariate regression analysis shows state legislative professionalism, healthcare professional networks, partisanship, state wealth, and severity of need are important factors in understanding the implementation of this policy. In addition, the insurance industry network, partisanship and public opinion, and severity of need (healthcare professional shortages) consistently matter in diffusion of telehealth enabling laws. Despite the gains that the 50 states have made in adopting telehealth policy, this research reveals the contours of a telehealth divide that mirror the well-known digital divideâ??those most able to use telehealth have higher incomes, education, and are white, rather than racial minorities. This research has important normative implications for the expansion of healthcare access through telehealth in America. It suggests policy at the state level (enabling laws) are necessary for the expansion of telehealth, as well as policy to address inequalities in technology access and skills (digital divide). |