New Jersey State Policy Lab: Use of Telehealth Among Essential Workers During COVID-19

March 30, 2022

by Mriga Bansal and Naren Gopal for New Jersey State Policy Lab

Since December 2020, coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been a significant global health concern. In February 2020, the Centers for Disease Control and Prevention (CDC) issued guidance advising individuals residing in areas affected by the COVID-19 pandemic to adopt social distancing practices, which included the option of using telehealth clinical services. Telehealth visits increased by 154% in the last week of March of 2020, compared with the same period in 2019.

The Department of Labor Statistics reports that 107.5 million individuals worked in pandemic-essential industries in 2019 (before the pandemic). Despite the critical nature of their work, essential workers usually earn low wages and are not entitled to such employment benefits as retirement plans and health insurance.

The pandemic has exacerbated socioeconomic disparities and access to healthcare, especially among vulnerable populations (e.g., those in racial/ethnic, ability, immigrant, or other groups that can be marginalized). One of the first descriptive studies to evaluate racial differences in COVID-19 mortality among essential workers in the US reported that Non-Hispanic Blacks died at a rate disproportionately higher than their representation in their state’s population. For example, although constituting only 6.17 percent of Wisconsin’s population, non-Hispanic Blacks accounted for 36.49 percent of COVID-19 deaths in that state. Notably, non-Hispanic Blacks were more likely than non-Hispanic Whites to work in essential occupations (e.g., transportation, health care, food preparation, and cleaning services). In states like Illinois, South Carolina, Louisiana, Georgia, and Mississippi, over 50% of COVID-19-related deaths occurred among Black adults and Latino adults. Non-Hispanic Blacks disproportionately worked in the top nine occupations that put them at high risk of getting COVID-19, and possibly infecting their households.

The Bloustein School of Planning and Public Policy at Rutgers University conducted the COVID-19 Impact Survey of a representative sample of 1,000 New Jersey residents[i] April 7-12, 2021. The survey asked respondents to identify their occupation from a list of essential worker categories[ii] (or none of the above). We found that, during the pandemic, essential workers in New Jersey were more likely than non-essential workers to use telehealth services (53% versus 47%), and that frontline healthcare workers were most likely to use telehealth services (among essential workers).

Considering that healthcare workers are aware of the types of healthcare services available during the pandemic, disseminating information more widely about the availability of telehealth services would likely increase the use of such services. The survey also found that the use of telehealth was greatest among individuals ages 30-45 years, as well as among those with bachelor’s degrees, with income between $90,000 and $149,000, and/or with health insurance. Notably, individuals with family/employer-provided insurance plans (i.e., commercial insurance) were more likely to use telehealth services than those with public insurance (e.g., Medicaid and Medicare).

Given their exposure, essential workers are at a higher risk of contracting the COVID-19 virus as they need to report to work, (i.e., cannot work from home), and may encounter challenges adhering to COVID-19 safety and social distancing protocols. Moreover, the low wages associated with essential work can lead to poverty-related lifestyles, affecting nutrition, immunity, and overall health, and increasing susceptibility to infection. Improving access to health care for essential workers is critical to ensure the stability of the health workforce during the COVID-19 pandemic and beyond.

Mrigra Bansal is PhD student in Economics at Rutgers University. Naren Gopal is a Master of Health Administration (MHA) student at Rutgers University.

[i] The margin of sampling error was +/- 2.5 percentage points.

[ii] The COVID-19 Impact survey identified an essential worker as any working individual who said they work in the following fields:
1. Frontline healthcare worker
2. Grocery store associate
3. Mail and Delivery personnel
4. First responder
5. Public transportation personnel

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