Cost is often cited as one of the biggest barriers to medical care. For people living with COPD, access to pulmonary rehabilitation is critical to their overall health. And while virtual care has increased access to this vital tool, a new study suggests that a lack of insurance coverage may be a barrier to access for many patients.
The paper, “Who Enrolls After Referral to Virtual Pulmonary Rehabilitation? A Descriptive Comparison,” was published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation.
According to the paper, pulmonary rehabilitation (PR) is one of the most effective treatments for patients with COPD, yet it remains one of the most underutilized, with less that 5% of eligible patients participating in PR programs. And of those who do participate, 55% do not complete the program.
Access to an in-person program is one of the barriers, according to the researchers said. AEven among those with Medicaid, nearly 40% had poor access to PR, with only one center within range for every 6,030 individuals with COPD in the United States.
Virtual PR programs, which saw a significant rise during the COVID-19 pandemic, would seem to be an ideal solution, but there are still barriers to participation, including cost. The researchers studied 278 patients who were referred to the Kivo Health VPR program in San Francisco, California, between July 1, 2023, and August 31, 2025. Of those, just 22.7% either completed the program or were still active in it at the time of data collection.
Among those who declined to participate, the most common reason cited (17.8%) was the program was out of network. The study also found no significant differences in demographics among those who had enrolled in the program compared to those who had not.
“While virtual pulmonary rehabilitation can help overcome geographic barriers to care, insurance coverage remains a significant and growing barrier for people who could benefit from these services,” said study senior author Lauren Egger, MD, of the University of California San Francisco, in a press release. “Importantly, we found that socioeconomic vulnerability, race, and language were not major barriers to enrollment. Our findings underscore the need to expand reimbursement for telehealth-based PR so that more people with COPD can access this important component of care.”
