Virtual Care and the Inverse Care Law: Implications for Policy, Practice, Research, Public and Patients

Hassane Alami (), Pascale Lehoux, Sara E. Shaw, Chrysanthi Papoutsi, Sarah Rybczynska-Bunt and Jean-Paul Fortin
Additional contact information
Hassane Alami: Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
Pascale Lehoux: Center for Public Health Research and Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, QC H3C 3J7, Canada
Sara E. Shaw: Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
Chrysanthi Papoutsi: Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
Sarah Rybczynska-Bunt: Community and Primary Care Research Group, Faculty of Health, Plymouth University, Plymouth PL6 8BX, UK
Jean-Paul Fortin: VITAM Research Centre on Sustainable Health, Faculty of Medicine, Laval University, Quebec, QC G1J 2G1, Canada

IJERPH, 2022, vol. 19, issue 17, 1-16

Abstract: Virtual care spread rapidly at the outbreak of the COVID-19 pandemic. Restricting in-person contact contributed to reducing the spread of infection and saved lives. However, the benefits of virtual care were not evenly distributed within and across social groups, and existing inequalities became exacerbated for those unable to fully access to, or benefit from virtual services. This “perspective” paper discusses the extent to which challenges in virtual care access and use in the context of COVID-19 follow the Inverse Care Law. The latter stipulates that the availability and quality of health care is inversely proportionate to the level of population health needs. We highlight the inequalities affecting some disadvantaged populations’ access to, and use of public and private virtual care, and contrast this with a utopian vision of technology as the “solution to everything”. In public and universal health systems, the Inverse Care Law may manifests itself in access issues, capacity, and/or lack of perceived benefit to use digital technologies, as well as in data poverty. For commercial “Direct-To-Consumer” services, all of the above may be encouraged via a consumerist (i.e., profit-oriented) approach, limited and episodic services, or the use of low direct cost platforms. With virtual care rapidly growing, we set out ways forward for policy, practice, and research to ensure virtual care benefits for everyone, which include: (1) pay more attention to “capabilities” supporting access and use of virtual care; (2) consider digital technologies as a basic human right that should be automatically taken into account, not only in health policies, but also in social policies; (3) take more seriously the impact of the digital economy on equity, notably through a greater state involvement in co-constructing “public health value” through innovation; and (4) reconsider the dominant digital innovation research paradigm to better recognize the contexts, factors, and conditions that influence access to and use of virtual care by different groups.

Keywords: virtual care; inverse care law; determinant of health; direct-to-consumer; telehealth; digital health; health policy; equity; capabilities; COVID-19 (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (3)

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