The Impact of Telemedicine on Health Equity in Underserved Populations: A Systematic Review

Abstract

The rapid digitization of healthcare delivery, accelerated significantly by the COVID-19 pandemic, has positioned telemedicine as a cornerstone of modern medical practice. While intended to bridge geographical and logistical barriers, concerns persist that the "digital divide" may exacerbate existing health disparities among underserved, marginalized, and rural populations.

This systematic review evaluates whether telemedicine interventions contribute to reducing health inequities or inadvertently create new barriers for vulnerable populations, specifically examining access, quality of care, and health outcomes.

Following PRISMA guidelines, a systematic search was conducted across PubMed, CINAHL, and Web of Science for peer-reviewed studies published between 2016 and 2026. Inclusion criteria focused on telehealth interventions targeting underserved populations—defined by socio-economic status, geographical remoteness, or ethnic minority status.

Twenty-eight studies were synthesized. Findings suggest that while telemedicine significantly increases accessibility for rural patients by reducing travel burdens, it often fails to reach the "deeply marginalized" due to the digital divide (lack of broadband, device literacy, and digital infrastructure). Outcomes are highly dependent on the "user-friendliness" of interfaces and the availability of bridging services, such as community-based facilitators.

Telemedicine holds significant potential for promoting health equity, but only if implemented as a supplement to, rather than a replacement for, traditional care. Structural interventions focusing on universal broadband access and digital literacy training are essential to prevent the deepening of systemic health inequities.