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Rural Health Care’s Broadband Gap Widens


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Health care institutions in non-metro counties have significantly slower broadband than metropolitan institutions do, a new study shows. And the gap is getting bigger.

By Brian Whitacre, Denna Wheeler and Chad Landgraf

The Daily Yonder

A new study suggests that health care facilities in non-metropolitan counties connect with relatively slow speeds when compared to their metro counterparts. More importantly, it also indicates that this connectivity gap is growing.

The finding comes at a time when the health care field has changed dramatically, with technologies such as electronic health records and health information exchanges becoming commonplace. These technologies require Internet connections – and, as more and more data is being transferred, those connections need to be fast.

The study takes advantage of the fact that the National Broadband Map gathered data on connectivity speeds for a variety of “community anchor institutions” – including health care facilities – during its run from 2010 to 2014. Each state surveyed its own facilities, and the resulting database included over 35,000 health care entities in 2010 and increased to over 62,000 in 2014. The location of each facility was also recorded, allowing for analysis of whether the connection speeds varied across metro/non-metro designations.

High-speed connections (>50 Megabits per second) for healthcare facilities increased dramatically in metropolitan areas between 2010 and 2014, but only slightly in non-metropolitan areas. The purple portion of the bars represents the percentage of facilities with 50 Megabits or more connection speeds. From 2010 to 2014, the gap between metro and non-metro healthcare facilities at that connection speed grew by 34 points.

High-speed connections (> 50 megabits per second) for health care facilities increased dramatically in metropolitan areas between 2010 and 2014, but only slightly in non-metropolitan areas. The purple portion of the bars represents the percentage of facilities with 50 megabits or more connection speeds. From 2010 to 2014, the gap between metro and non-metro health care facilities at that connection speed grew by 34 points. Graph courtesy Daily Yonder.

(Note: This story uses metropolitan and non-metropolitan counties to compare urban and rural trends. In rough terms, metro counties have a city of 50,000 residents or more at the center of their economic activity; non-metro counties don’t. But it’s more complicated than that. Read more about different ways to define “rural” here.)

The results (as depicted in the chart above) show a significant difference in the speeds at which health care facilities connect between metro and non-metro areas.  In 2010, 14 percent of all health care facilities in metropolitan areas had the fastest category of connections (at least 50 megabits per second).  Comparatively, only about 5 percent of health care facilities in non-metro counties had connections of that speed. Non-metro facilities also had higher rates of the lowest category of speeds (less than 3 mbps), with 38 percent (vs. 33 percent in metro areas).

More striking, however, is how those rates changed between 2010 and 2014.  Health care facilities in metro areas saw their rates of “very fast” connections shoot up from 14 to 55 percent, while facilities in non-metro areas saw a much smaller increase (from 5 to 12 percent). Similarly, the percentage of metro facilities with “very slow” connections decreased from 33 to 11 percent, but non-metro connections of this type had a much slower decline (from 38 to 28 percent).

The result is that the health care connectivity gap was much worse as of 2014 than it was in 2010. Similar gaps exist for upload speeds (which are important for technologies like EHRs and HIEs).

The remainder of the study goes on to show that this gap is primarily driven by non-hospital facilities. The rate of growth for hospital connections between 2010 and 2014 is actually quite similar between metro and non-metro areas. However, when the analysis is done for non-hospital facilities (private practices, health departments, pharmacies, clinics, etc.), it becomes clear that the gap is dramatically increasing for these types of health care services.

Additionally, the Federal Communications Commission has recommended that solo primary care practices have speeds of at least 4 mbps and that small primary care practices, nursing homes and rural health clinics have speeds of at least 10 mbps. The latest data (from 2014) indicates that a significant portion of rural health care facilities are not meeting these requirements.

Vintage computer image

Vintage computer image courtesy of Alan Light, flickr creative commons

This increasing connectivity gap happened despite the existence of a pilot (and resulting full-time) program called the Healthcare Connect Fund. This program had funds available to support broadband connectivity for public or not-for-profit health care providers including hospitals, rural health clinics and local health departments.

However, the fund is dramatically underused, perhaps due to overly stringent requirements. This research suggests that changes to this program should be considered to encourage participation by non-hospital facilities.

Brian Whitacre is associate professor and extension economist at Oklahoma State University. The study is forthcoming in the Journal of Rural Health and is entitled “What Can the National Broadband Map Tell Us About the Healthcare Connectivity Gap?

This story originally appeared here and is shared by North Carolina Health News through a content-sharing agreement with the Daily Yonder, a not-for-profit news agency dedicated to covering rural policy.

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