In fully rural counties, improved broadband availability is associated with greater use of telemedicine, and the Federal Communications Commission’s (FCC’s) Connect America Fund should target these communities to help alleviate disparities in healthcare access, according to a letter published in JAMA Internal Medicine.

Investigators sought to explore whether broadband availability in rural communities is associated with telemedicine use, including use of healthcare services delivered remotely through telecommunications.

Per capita rates of telemedicine visits for each US county were calculated by analyzing data from a nationally representative sample of Medicare beneficiaries and privately insured enrollees. Telemedicine visits were counted as health claims with a telemedicine modifier or telemedicine-specific code. Broadband access — defined as internet download speeds of at least 25 megabytes per second and upload speeds of at least 3 megabytes per second — was measured at the county level using the FCC’s Fixed Broadband Deployment Data. Broadband categories were characterized as low availability (0% to 40%), medium availability (>40% to 70%), or high availability (>70%). A sample of 2785 counties was categorized according to rurality: metropolitan counties with rural residents, nonmetropolitan counties with smaller towns/cities (≥2500 urban residents), and nonmetropolitan counties without urban areas (fully rural residents). Analyses were controlled for county-level socioeconomic characteristics, per capita hospitals, health centers, psychiatrists, and state-level commercial reimbursement regulations for telemedicine.

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Greater broadband access among fully rural counties (n=599) was associated with greater telemedicine use. Compared with rural counties with high broadband availability, rural counties with low broadband availability had 34% fewer telemedicine visits per capita (20.4 vs 13.4 per 1000 beneficiaries; P =.004). However, among metropolitan counties with rural residents (n=869) and nonmetropolitan counties with smaller towns/cities (n=1317), there was no association between broadband access and telemedicine use. When the investigators modeled commercial and Medicare rates separately and applied different cutoff values for broadband availability, the study results remained the same. The investigators also determined the distribution of the FCC’s Connect America Fund among the counties studied and found that only 16.1% went to fully rural counties.

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Including only wired broadband availability limited the study results, as it may not be representative of all connectivity options.  In addition, the study only captured information when healthcare professions billed for telemedicine visits.

The researchers concluded that greater availability of broadband was associated with greater use of telemedicine in fully rural counties only; however, funding from the FCC’s Connect America Fund is largely targeted at counties in which this association was not observed. Increasing the funding to fully rural counties may help alleviate disparities in access to specialists.


Wilcock AD, Rose S, Busch AB, et al. Association between broadband internet availability and telemedicine use [published online July 29, 2019]. JAMA Intern Med. doi: 10.1001/jamainternmed.2019.2234