Broadband access disparities by the numbers
While telehealth usage has declined since the early days of the pandemic, it is clear patients and providers are now more accepting of this form of care delivery. From mental health consults to post-surgical follow-ups, shifting care to the patient’s home (when medically appropriate) is an attractive option to many.
However, broadband internet access—designated a social determinant of health (SDOH) by the U.S. Department of Health and Human Services (HHS)—is far from ubiquitous in the United States. It is worth noting 85% of U.S. adults own a smartphone, but cellular signals tend to be weaker, making them suboptimal for telehealth visits. Plus, patients may be hesitant in using up minutes on their phone plans for extensive calls.
To understand the far-reaching issue of internet inaccessibility, let’s dive into the numbers.
Defining and measuring internet access
One challenge with addressing broadband disparities is the variability in defining and measuring access. For example, the Federal Communications Commission (FCC) reports that 14.5 million Americans live in areas without access to broadband. Contrast this to Microsoft research, which estimates as many as 120.4 million people do not use the internet at broadband speeds. Additionally, a survey from the Pew Research Center indicates 23% of American adults do not have broadband service at home.
While these studies define the ability to use broadband differently, the gaps between these figures suggest internet disparities may be greater than we think.
Like many SDOH, trends in broadband access can be found along socioeconomic and demographic lines. Regarding race, 80% of white adults have broadband at home, compared to 71% of Black and 65% of Hispanic adults. Moreover, the FCC reports that 65% of housing units on rural American Indian and Alaska Native land have access to broadband service, while 99% of urban housing units have access.
Drilling further into community type, though, we see a different picture. U.S. Census data shows that approximately 81% of all rural households have a broadband subscription, compared to 86% of urban households, equating to 4.6 million rural and 13.6 million urban households. This comparison demonstrates that local infrastructure does not always equal access.
As one might suspect, income is a major predictor of home broadband usage. According to the Pew Research Center, broadband use by annual household income is as follows:
- Less than $30,000: 57%
- $30,000–$49,999: 74%
- $50,000–$74,999: 87%
- $75,000+: 92%
Of those who do have broadband at home, affordability remains a concern for many; nearly half of low-income and a quarter of middle-income adults say they worry “a lot” or “some” about being able to pay for their broadband over the next few months.
We can also see broadband disparities when segmenting by generation. Adults over 65 and those 18–29 have lower rates of home broadband adoption (64% and 70%, respectively) than those 50–64 and 30–49 (79% and 86%, respectively). And even if patients have broadband, they may not have the technical skills needed to engage in virtual visits. For example, research suggests an estimated 10.8 million older adults may have trouble accessing telehealth.
Serving patients with broadband barriers
Providers cannot rely on what they see to determine which patients can reliably use telehealth. Thus, it is crucial to screen all patients for SDOH at regular intervals in case their internet availability changes between visits. This is particularly important during the pandemic as in-person care may be canceled or postponed due to COVID-19 surges. Without screening procedures in place, providers may inadvertently suggest video visits to patients who cannot attend those appointments.
While video visits may be preferable at times, providers should consider offering telephone visits in place of video visits (when clinically feasible) for patients lacking broadband, video-enabled devices or the digital literacy needed to navigate video visits. Additionally, healthcare organizations can arrange non-emergency medical transportation through on-demand services like Allscripts® Go for patients with transportation needs when telehealth visits are not an option.
As healthcare evolves digitally, practices must continue to ensure patients can receive the care they need, whether online or in person. Broadband access disparities will not be solved overnight, but with flexible and creative approaches, providers can help bridge the digital divide.