Use of e-Health Services between 1999 and 2002: A Growing Digital Divide
- Affiliations of the authors: Kaiser Permanente Medical Care Program, Oakland, CA (JHs, JHu, JK, BF, JS); University of California, San Francisco, San Francisco, CA (RM); Veterans Affairs Medical Center, Washington, DC (EO)
- Correspondence and reprints: John Hsu, MD, MBA, MSCE, 2000 Broadway, 3rd Floor, Oakland, CA 94612; e-mail: < >
- Received 13 August 2004
- Accepted 1 November 2004
Objective To evaluate the patterns of e-Health use over a four-year period and the characteristics of users.
Design Longitudinal, population-based study (1999–2002) of members of a prepaid integrated delivery system. Available e-Health services included ordering prescription drug refills, scheduling appointments, and asking medical questions.
Measurements Rates of known access to e-Health services, and of e-Health use each quarter.
Results The number of members with known e-Health access increased from 51,336 (1.6%) in 1999 to 324,522 (9.3%), in 2002. The percentage of households in which at least one person in the household had access increased from 2.7% to 14.1%. Among the subjects with known access, the percentage of subjects that used e-Health at least once increased from 25.7% in 1999 to 36.2% in 2002. In the multivariate analysis, subjects who had a low expected clinical need, were nonwhite, or lived in low socioeconomic status (SES) neighborhoods were less likely to have used e-Health services in 2002. Disparities by race/ethnicity and SES persisted after controlling for access to e-Health and widened over time.
Conclusion Access to and use of e-Health services are growing rapidly. Use of these services appears to be greatest among persons with more medical need. The majority of subjects, however, do not use any e-Health services. More research is needed to determine potential reasons for disparities in e-Health use by race/ethnicity and SES as well as the implications of these disparities on clinical outcomes.
This research was performed by the Kaiser Foundation Research Institute through the support of the Agency for Healthcare Research and Quality (AHRQ) under Contract 290-00-0015, Task Order No. 8. The authors of this article are solely responsible for its contents. No statements or views in this article should be construed as official positions of AHRQ, the U.S. Department of Health and Human Services, Department of Veterans Affairs, or the Federal government.