Online Scheduling and the Digital Front Door to Unequal Care.

Abstract

Online appointment platforms are often viewed as tools of convenience, but they may reproduce and potentially amplify inequities rooted in underlying insurance and reimbursement structures. In this commentary, we highlight implications from a study using simulated profiles of patients with statutory health insurance (SHI) and private health insurance (PHI) to conduct an internet-based audit of online appointments. Not only was the time to the first available appointment longer for SHI than PHI patients, but also the PHI profile had access to more listings with appointments, and listings offering earlier PHI than SHI appointments appeared higher in search results than listings offering the same appointment timing to both. Accounting for strengths, limitations, and opportunities for future research, the study suggests several policy implications. First, leaders should view online scheduling platforms as access infrastructure, not merely convenience tools, and evaluate them with respect to access and disparities, not only adoption and satisfaction. Second, future evaluation and work should treat access as multidimensional, assessing multiple measures of access and comparing online with other scheduling channels. Third, insurance and delivery reform should accompany actions to govern digital platforms, which can organize and display, but cannot alone eliminate, disparities rooted in reimbursement and care structures. Ultimately, the relevant question about online scheduling platforms is not only whether such systems make booking easier but also whether they narrow, preserve, or widen broader health system inequalities. Digital front doors should be judged both by how easily they open and whether patients have equitable opportunities to pass through them.