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I used to write about rural lands and life on Native American reservations. In some places, there’s only one doctor for an entire community. In others, a revolving door of clinicians and therapists make it harder for patients to receive comprehensive care.

What an amazing resource, then, could something like telehealth be for people in these far-flung, often marginalized communities who are suffering from depression, addiction or chronic diseases. Except It’s not really shaping up that way: Only 60% of people in rural areas have access to telehealth services, compared to 95% of people in urban settings, according to the Centers for Disease Control and Prevention.

Every now and then, a new trend emerges promising to “revolutionize” the health care industry—as though any one company has the power to influence all the fragmented and siloed segments of the health care complex and make them work together. As if we haven’t heard that promise before, and as if the problems that have consistently plagued the industry still don’t exist.

There’s actually a name for that phenomenon: The inverse care law, which was coined by British clinician Julian Tudor Hart in 1971 to describe the prevailing evidence that the people who need care the most tend to receive it the least. Throughout history, emerging technologies and treatments have become ubiquitous among the mainstream population while still overlooking those who needed them the most. Take ketamine therapy; the drug, which is used to help treatment-resistant depression and PTSD, can cost thousands of dollars—barring poor people, who are statistically most vulnerable to those conditions, from accessing it.

Telehealth is the most recent care frontier—one welcomed during the pandemic by governments and insurers alike, as many doctors shuttered their offices to those who did not specifically need in-person treatment. This morning, I wrote about local startup Ruth Health, which raised $2.4 million to offer digital prenatal and postpartum services to parents—an area far too overlooked by our existing health care system. I’ve previously written about Moving Analytics, which is using telehealth to tap into a health care segment that has one of the lowest retention rates, physical therapy. There’s also Within Health, which provides comprehensive virtual care for eating disorders.

As those companies grow and more like them pop up, we ought to think critically about the people who may not always be able to access what they offer. Because if our care gets better and their care stays the same, their care is actually getting worse. — Keerthi Vedantam