High-speed internet access is a new social determinant of health


According to the American Hospital Association, an estimated 76% of U.S. hospitals now provide some type of telemedicine service that requires broadband access with bandwidth fast enough to transmit audio and video.

While there is still the option of good old-fashioned phone calls, “that is not as good as a telemedicine visit where I can see the patient by video and assess different things,” Guerra said.

Susan Hull, a member of the board of directors for the American Medical Informatics Association, said tele- and virtual health approaches were adopted so quickly in the past year that it didn’t leave time for communities and healthcare providers to “take stock” of the digital divide.

“A common misconception is that those in underserved communities have smartphones,” said Dr. Michael Petersen, health innovation lead for global consulting firm Accenture. “What hasn’t been considered are the economic realities in which people shut their phones off to save time on their data plans.”

The average telemedicine consultation costs $70 compared with more than $140 for an in-person visit. But a smartphone can cost hundreds even without the average monthly charge of around $60 for broadband service.

Some stakeholders want providers to take up the issue with local governments. “Hospitals in communities where we’re supporting the construction of broadband networks could work with the broadband providers who won funds from the FCC—they could essentially say, ‘Look, you’re already building out to these 50 homes in this rural community, we want to talk about building the fiber line and extending the reach of your network so that we can do telehealth,’ ” said former FCC Chair Ajit Pai in an interview earlier this year. “That would be very powerful.”

Health insurers could also provide internet service to their members as part of their plans. While many insurers waived patient out-of-pocket telehealth costs during the pandemic, only a few have addressed the issue of broadband availability.

Last April, Anthem Blue Cross donated $100,000 to the United Way’s COVID-19 Response Fund to help low-income people pay their utilities, including broadband access.

“Is it the healthcare system’s responsibility?—I would say yes,” Guerra said. “I would like us to think about ways that we can perhaps pilot novel ways of getting people access to telemedicine.”