photo credit: Marco Verch (CC BY 2.0)
While the lack of broadband access in rural America is not a new problem, the necessity for immediate action is increasingly clear as rural residents and the health care facilities and providers who serve them are more reliant on telehealth in the time of COVID-19. Telehealth provides a wide array of services, from processing payments and scheduling appointments to conducting primary care visits via video. In this time of social distancing and strained health care systems, telehealth services are vital to “flattening the curve.”
Compounding the issue of an underdeveloped rural broadband infrastructure, is the lower patient-to-physician ratio in rural America, compared to urban counterparts, with nearly 77% of rural counties considered a health professional shortage area. Providing broadband access to rural populations and health care providers will not only help in the fight against COVID-19 but will boost the longevity of the community by connecting patients with the care they need. This Market Intel highlights the urgent needs of rural health care providers as well as the federal relief efforts underway.
Broadband infrastructure is a necessity in a modern economy and a critical part of providing access to adequate health care. For an aging rural population, telehealth can decrease the transportation burden for patients and physicians while ensuring the best patient care available. However, due to a lack of broadband access, rural patients and health care providers alike are unable to utilize the newest technologies.
Adherence to the CDC’s social distancing guidelines have compelled many rural health care facilities to close their non-emergency services. Because non-emergency services typically fund the daily operations of rural hospitals, these closures have put a financial strain on already-resource scarce rural facilities.
According to data from USDA’s Economic Research Service’s Atlas of Rural and Small-Town America county-level designations and the Health Resources and Services Administration, 88.2% of rural counties in the U.S. are considered medically underserved. For counties whose population is dependent on farming, 91.9% are medically underserved. Medically underserved areas are defined using a weighted average score of demographic and health indicators such as provider-per-1,000-people ratio, population over 65, population at the federal poverty level, and infant mortality rate. The index is based on a 100-point scale with zero signifying a county that is completely underserved. Any county with an Index of Medical Underservice score below 62 is considered medically underserved.
Based on the Index of Medical Underservice score defined by HRSA, the average score for rural and farming-dependent counties is 52.4 and 52.2, respectively. Over 20%, 452 rural counties, have an index score below 50. Figure 1 identifies the average Index of Medical Underservice score by county.
There are two predominate federal funding streams to deploy broadband infrastructure and services throughout rural America, USDA’s Rural Utilities Service and The Federal Communications Commission’s Universal Service Fund (USF). Reauthorized in the 2018 farm bill, RUS broadband programs fund infrastructure deployment of broadband and telecommunications throughout rural areas. The USF programs aim to defray the costs of broadband deployment in rural areas. For more details on this these programs visit “American Broadband Initiatives: A Work in Progress.”
The Coronavirus Aid, Relief, and Economic Security (CARES) Act has allocated $325 million for broadband infrastructure and telehealth initiatives to combat the current pandemic. USDA’s Rural Development programs for distance learning and telemedicine received $25 million, with an additional $100 million provided to the ReConnect program. Both Rural Development’s and ReConnect’s initiatives focus on grant and loan programs for rural broadband infrastructure buildout.
The CARES Act also provided a further boost to telehealth measures via an allocation of $200 million to the Federal Communications Commission for emergency telecommunication services for health care providers. In response, the FCC established the COVID-19 Telehealth Program, taking on the broader aim of meeting the immediate needs of health care providers during the pandemic. To address the longer-term needs of rural populations and access to telehealth services, the FCC also established the Connected Care Pilot Program out of the Universal Service Fund, making available $100 million over three years to examine how the Fund can support the trend toward telehealth.
Efforts on the Horizon
Currently, there are two separate issues related to broadband access in rural areas; the immediate need to bridge the telemedicine and distance learning divide and long-term action to bring broadband services to rural areas in order to utilize all technologies, such as precision agriculture.
Many rural hospitals were already strained for resources, but the current pandemic is quickly pushing them to an operational breaking point. To address the immediate needs of rural populations, some telecommunications providers are working with local hospitals and public libraries to provide Wi-Fi hotspots where cellular services are available. However, for areas where cellular service does not provide a strong enough signal, disaster relief tools such as cellular-on-wheels, also called COW, may be deployed. COW systems are trailer-mounted, transportable solutions for utilizing satellite and tower antenna technology to provide cellular services.
As more details of the implementation of federal emergency efforts to provide broadband services to rural areas come out this Market Intel will be updated. Visit USDA's COVID-19 Federal Rural Resource Guide for more information.
For the 60 million people living in rural America, access to consistent, up-to-date health care services and technology is a matter of life and death. These individuals face the same medical issues and needs as their urban counterparts; however, they do not have access to the same care. The underdeveloped rural broadband system has created barriers to basic health care.
In order to bridge the telemedicine and distance learning gaps in rural America, immediate action must be taken to provide households and health care facilities with all necessary resources. Within the CARES Act, $325 million has been dedicated to fund broadband infrastructure. While the spread of COVID-19 cases in rural areas is not as high as dense urban areas, the rural healthcare system has already been greatly diminished and will not be able to handle the further strain. Moving forward, it will be all-hands-on-deck to deploy broadband and continue to monitor the healthcare needs of rural America.