Before the COVID-19 pandemic, telemedicine (TM) in Colombia was underutilized and not fully integrated into the healthcare system. Although the Ministry of Health and Social Protection (MHSP) enacted regulations between 2007 and 2019 to promote and standardize TM (1, 2), its implementation remained limited to a few public and private health insurances providers (3, 4). The onset of the pandemic and the nationwide mandatory quarantine from March 24 to July 15, 2020, radically altered healthcare delivery. Routine outpatient visits and elective procedures were suspended, and the healthcare system faced the urgent need to offer medical services virtually (5–7). In response, the Colombian government encouraged both public and private insurers to rapidly expand telemedicine services. As a result, over 3 million TM consultations were conducted in the first 2 months of the pandemic alone (7), and more than 42 million by January 2021 (8–10).

SURA, one of the largest insurers in the country, provided 2.6 million telemedicine consultations between March 2020 and June 2021. SURA covers approximately 30% of the insured population in Colombia, reaching around 13 million individuals across urban and rural regions, with benefit package and copayment structure comparable to those of other major insurers. The broad and diverse coverage reduces the risk of strong selection bias and allows findings from SURA to be more generalizable both within Colombia and to other middle-income countries with similar mixed health systems (11). Despite this massive expansion, there is limited evidence on the profile and distribution of TM users during this period. This knowledge gap has important implications: without a clear understanding of who accessed telemedicine services, policies and programs risk reinforcing inequities in access to healthcare. Evidence from other Latin American countries illustrates these consequences. In Brazil, targeted investments in digital health infrastructure during the pandemic improvement continuity of care in underserved areas, reducing disparities in service use (12, 13). By contrast, in Peru, limited adoption and lack of equitable access to TM left vulnerable populations further marginalized during the health emergency.

This study aims to describe the sociodemographic characteristics of TM within a major Colombian insurance provider. The findings may inform future healthcare policies, training and digital health interventions. Moreover, they can provide insights for other health systems in low-and middle-income countries seeking to sustain and scale telemedicine services beyond the pandemic.

The aim of this study was to describe the sociodemographic characteristics and health conditions of telemedicine (TM) users within a large Colombian insurance provider during the COVID-19 pandemic. Our principal findings show that over 2.6 million insured individuals used telemedicine services, spanning diverse demographic groups and health conditions (8–10). The adoption of telemedicine occurred not only among individuals with chronic conditions, such as hypertension and diabetes, but also in a wide range of non-chronic conditions. Usage extended to both pediatric and older adult populations, indicating a systematic shift in the delivery of care that transcended age, gender and socioeconomic status.

One of the most significant findings is that a higher proportion of individuals from low-income and subsidized groups were primary users of telemedicine. This challenges the pervasive notion that digital health may inherently widen inequalities due to disparities in internet access or digital literacy (14, 15). In our context, telemedicine appeared to function as a mechanism of health equity, allowing vulnerable populations to access timely care without the barriers of transportation costs, time off work, or exposure to infections (14). This is consistent with findings in other settings, such as in the United States, where Cantor et al. (2021) showed that telehealth expansion during the pandemic helped maintain access across sociodemographic groups (16). However, it contrasts with findings in low-resource settings like Ghana and Nigeria, where Dodoo et al. (17) described persistent inequalities in telemedicine access, emphasizing that context-specific infrastructure and governance play a decisive role in shaping digital health equity.

Women accounted for nearly two-thirds of all TM users. This may reflect increased healthcare-seeking behavior among women but could also point to their central role in family health management, particularly during public health emergencies (18, 19). These findings mirror regional and global patterns, where women are more likely to access primary care and chronic disease services, and may be disproportionately responsible for coordinating care for children and older relatives. From a geographical standpoint, telemedicine services were delivered across nearly all departments of Colombia, even though the insurer does not operate in every region. The strategic deployment of primary care units (PCUs) as nodes for virtual care made it possible to overcome some of the limitations imposed by the country’s persistent digital divide (20). The Economic Commission for Latin America and the Caribbean (CEPAL, 2020) has emphasized that such digital gaps remain one of the most pressing structural challenges to inclusive telehealth in the region (20). Nevertheless, the present study shows that even in a middle-income country with unequal connectivity, a rapid and massive adoption of telemedicine was possible, highlighting the latent capacity for digital transformation within health systems when aligned with urgent public health needs (21, 22).

Importantly, the structure and timing of this study offer unique insights. Unlike most reports from Colombia during the pandemic, which focused on specific hospitals, cities, or disease categories, our analysis captures the full spectrum of patients utilizing telemedicine in a large insurance network. It reveals not only who used telemedicine, but also how usage patterns varied by sociodemographic and clinical factors—critical information for scaling digital health solutions in a post-pandemic landscape. The inclusion of diagnostic categories further enriches our understanding of the types of conditions managed virtually, ranging from respiratory symptoms and acute infections to endocrine and mental health conditions. These results also provide empirical support for the conceptualization of telemedicine not as a temporary substitute during crisis, but as a viable and scalable modality for sustained healthcare delivery (23, 24). The rapid uptake of virtual consultations by both providers and patients underscores a level of digital readiness in the Colombian health system that had not previously been quantified. Moreover, the shift was accomplished without significant exclusions along income or age lines, suggesting a window of opportunity for institutionalizing telemedicine as part of the routine healthcare model.

For health professionals, these findings highlight the need for strengthened training in telemedicine competencies to ensure high-quality virtual care. For policymakers, they emphasize the importance of sustained investments in digital infrastructure, equitable findings models, and comprehensive regulatory frameworks to guarantee continuity, quality, and data protection. For researchers, future work should assess patient outcomes, satisfaction, and long-term health impacts; explore provider perspectives and barriers to adoption; and conduct longitudinal and comparative analyses to evaluate the sustainability and equity of telemedicine services (20). Taken together, the Colombian experience demonstrates that, beyond its role in public health emergencies, telemedicine has the potential to address persistent challenges in healthcare delivery – such as geographic inequities, provider shortages, continuity of care for chronic conditions, and access for marginalized populations. It should no longer be viewed merely as an emergency response, but as a strategic component of resilient, patient-centered health systems capable of adapting to the evolving needs of diverse populations.

This study offers valuable insights into telemedicine use in Colombia; however, some limitations should be acknowledged. While the dataset encompasses a large and diverse sample of over 2.6 million individuals, it represents enrollees from a single health insurance provider, which may not fully capture the heterogeneity of the national population. Nonetheless, this insurer covers a broad geographic and demographic spectrum, offering a meaningful lens into real-world implementation. Additionally, to protect patient confidentiality, geographic information was limited to primary care unit assignments, restricting detailed analysis of urban–rural disparities. Although we did not include measures of digital literacy, internet access, or user experience—key aspects of digital equity—our findings still provide a foundational understanding of sociodemographic access patterns. Finally, while disaggregation of some variables was limited due to privacy considerations, the overall trends observed offer a robust starting point for future research and policy development in digital health.

This study provides population-level evidence that telemedicine was central to preserving healthcare access in Colombia during the COVID-19 pandemic. Its widespread adoption across age, gender, and socioeconomic groups underscores its role as a mechanism for advancing health equity rather than serving solely as a temporary substitute. The Colombian experience demonstrates the country’s capacity for digital health innovation and offers a scalable reference for other LMICs seeking to integrate telemedicine into routine care. To secure lasting transformation, sustained political commitment, strategic infrastructure investment, and equity-oriented policies will be essential.