Technology-Mediated Services in Health Care: Evaluating Telehealth Delivery Models for Underserved Populations

This study examines how telehealth delivery models are associated with access to care and protocol adherence in underserved populations. While prior research reports mixed evidence on telehealth’s effectiveness, we argue that these inconsistencies arise because telehealth is not a single intervention but is implemented through distinct service configurations that address different barriers. Drawing on the theoretical framework of digital economics, we conceptualize telehealth as a technology-mediated service that can alter key economic frictions, including search and verification, transportation, tracking, and setup costs. We focus on two widely adopted models—specialist-facilitated telehealth and remote telehealth—and theorize that each addresses different subsets of these frictions, leading to distinct effects on care access and protocol adherence across settings. Using panel data from U.S. Community Health Centers on mental health services, we document three findings. First, adoption of the specialist-facilitated model is associated with increased access to mental health care, particularly in areas with greater clinical need. Second, remote telehealth is not associated with increased access on average but is associated with higher adherence to standardized depression screening and follow-up protocols. These effects are consistent with improvements in screening and documentation processes rather than increases in utilization. Third, the estimated effects of both models vary across local cost environments. The access effects of specialist-facilitated telehealth are larger in areas where search and verification frictions are greater. In contrast, the effects of remote telehealth are attenuated where patient-side setup costs are high but are larger where transportation barriers and documentation frictions are greater. These findings advance a model-specific perspective on telehealth’s effects, extend the digital economics framework to technology-mediated services, and provide evidence that the estimated effects of digital health interventions vary with how delivery models interact with underlying cost environments.