Telemedicine Use in a Fragmented Federal System: State Policy Variation and Access to Digital Health Services in the United States

This article examines how fragmented governance shapes access to digital public services, focusing on telemedicine use in the United States during the 2021 to 2022 pandemic recovery. Using U.S. Census Bureau Household Pulse Survey data combined with state-level differences in reimbursement policies, licensure rules, and emergency waivers, the study analyzes whether telemedicine access varies across policy environments, controlling for individual characteristics and health needs. Findings show that telemedicine use is strongly associated with intergovernmental policy configurations, along with personal resources. The study highlights how federal and state institutions structure access, producing uneven opportunities for digitally mediated care across populations and territories. JEL codes: I18, H77, H75