Inequity in primary healthcare for older adults in Finland: in-person vs. telemedicine doctor visits

Abstract Background International evidence often shows pro-poor inequities in primary care doctor (PCD) service use. In Finland, the public (municipal) sector remained the primary provider of primary care for adults aged 65 and older (65+) until 2022. However, ageing-related demand, shortages of PCDs and other healthcare professionals, and health centre closures have challenged access to healthcare, while telemedicine use expanded particularly during the COVID-19 pandemic. We examined inequities in the use of public PCD services among older adults in Finland from 2015 to 2022. Methods We used data on public PCD visits from the national primary healthcare register (2015-2022) for adults aged 65+, linked to individual socioeconomic data and chronic health condition records from multiple national registers. Visits were classified as in-person, real-time telemedicine (phone/video), or non-real-time telemedicine (letters/emails/chats). The analysis included about 8 million individuals. Inequity in utilisation (the number of PCD visits in a year) across income levels was examined using the horizontal inequity (HI) index. Need-predicted utilisation was estimated with negative binomial regression, adjusting for demographic, health condition, socioeconomic, travel time, and regional factors. Results In-person visits declined until 2020, followed by a slight rebound. Telemedicine visits showed modest increases, particularly non-real-time visits during the pandemic. In-person care initially exhibited mild pro-poor inequity, which reversed over time, with recent years favouring higher-income groups. Telemedicine use consistently showed pro-rich patterns although pro-rich inequities in telemedicine use briefly reduced during the pandemic. Overall use was skewed towards higher-income groups. Conclusions Inequities in public PCD utilisation among older adults have widened in recent years, particularly with the growing role of telemedicine. Key messages • Policies are needed to reduce disparities in healthcare access and use, particularly among low-income and vulnerable populations. • Enhancing digital literacy among older adults may improve equitable access to telemedicine.