Who Gets to Go to the Clinic? Expanding Equity Considerations in DTC Telemedicine

The USA has some of the highest costs of medical care in the world. Telemedicine has been proposed as an affordable alternative to traditional in-person care, increasing access to medical services. Praised as a significant innovation and opportunity to expand access to medical care, telemedicine services have rapidly expanded in the wake of the COVID-19 pandemic. This viewpoint discusses the equity implications of the expansion of direct-to-consumer telemedicine-only medical care or care, which takes place entirely in the virtual realm, often with no requirement for a previous patient-provider relationship. We propose an approach to digital health that looks beyond digital literacy and access to technology to consider systemic challenges to equitable implementation.