COVID-19 has propelled the nation into widespread telehealth services to provide consumer-based care, especially for those who access this technology. Equity issues arise when using digital communication because many underserved populations lack access to digital and/or mobile services. Inevitably, this brings up the greater concern of an unintentional exacerbation of disparities because low-income groups face limited access to both computers, mobile services, and the internet. Hence, investing in access to the internet and smartphones should be prioritized for underserved populations. As telehealth expands, broadband providers and municipal broadbands will cater to the demands in unserved areas by expanding their internet services.
Telecommunication shortages in rural areas
Lack of infrastructure and internet connectivity in underserved communities imposes a barrier to expanding mobile digital health. A 2019 Pew Research Center report states that more than four-in-ten do not have home broadband services (44%) or a traditional computer (46%) because of financial obstacles. The Federal Communications Commission’s (FCC) 2020 Broadband Development report also identified disparities in which approximately 77.4% of Americans in rural areas and 72.1% of Americans in tribal lands have internet services as compared to 98.5% of Americans living in urban areas. Before COVID-19, major broadband providers such as Comcast and Charter have little economic incentive to cover rural areas because of the minimal return in revenue; wiring rural areas is expensive and rural areas have too few households for these providers to receive a good return on investment.
Even though these limitations exist, telehealth can continue to grow as broadband and telecommunication services expand, particularly during this pandemic. As stated in the Broadband Internet Services Global Market Report 2020-30: COVID-19 Implications and Growth report, the global broadband internet services market is expected to grow from $263.4 billion in 2019 to about $355.6 billion in 2020. There is an increasing demand for immediate services with convenient access in a digital age, especially in rural and low SES areas. Grandview Research’s 2020 market analysis report reveals that the global telecommunication services market size was valued at USD 1.74 trillion in 2019 and is expected to grow at a compound annual growth rate (CAGR) of 5.0% from 2020 to 2027. This is consistent with the trend that 26% of adults living in households earning less than $30,000 a year do not have broadband internet at home but use telecommunication services, making them “smartphone-dependent” internet users. As more consumers explore cloud-based services and use mobile devices, there is a trend towards increased spending on wireless communication infrastructures.
In recent years, there has been a surge in competition between broadband providers and municipal-owned broadbands due to unserved areas’ demands. IBISWorld’s 2020 market research report states that there is a push towards broadband expansion in rural markets and a rise in demand from business customers. This has boosted industry revenue, which has experienced an annualized growth of 1.2% to $115.6 billion over the five years to 2020. According to the Institute for Local Self-Reliance’s 2018 Profiles of Monopoly report, major broadband providers, such as Comcast and Charter, run a de facto monopoly where each company provides internet services to their own areas, eliminating competition. However, rising competition from municipal broadbands’ affordable and faster services, and the COVID-19 impact on the internet, has prompted major broadband providers to engage in network expansion projects throughout the unserved communities. To make the internet more accessible for low-income Americans, Comcast has also decided to lower the cost and increase the internet speed as part of its Internet Essentials program. Spending $17 million on a digital equity plan, Comcast plans to provide free internet access for 35,000 low-income families in Philadelphia. As a consequence of the expansion of broadband services, there will be an increase in people who can access telehealth.
COVID-19 has shined a light on the disparities in access to internet services. As broadband service inequities slowly subside, telehealth can serve more Americans from diverse geographic and socioeconomic backgrounds, which has historically been unmet. Connectivity has expanded, and along with it, the populations with access to telehealth to help serve their health care needs. Today, telehealth integrates with expanding technology infrastructure, allowing health care systems to accelerate toward a consumer-centric model.
Sammi Wong is a medical student. Krysti Lan Chi Vo is a psychiatrist.
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