There is sufficient evidence that access to improved broadband is associated with increased telehealth utilization.
The findings below synthesize the results of the studies on broadband internet access across three domains of measurement:
Although broadband access in the United States (U.S.) has been steadily increasing, with 92% of households having a broadband internet subscription in 2021 compared to 85% in 2018[1], about 10 million Americans are still without home internet[2]. This access gap is especially pronounced among rural, low-income, and minority populations[3],[4],[5]. For example, in 2023, only 54% of households earning less than $25,000 a year had reliable home internet access, compared to 80% of those earning $100,000 or more[6]. The Federal Communications Commission (FCC) defines broadband internet as service with minimum speeds of 100 Mbps for downloads and 20 Mbps for uploads[7].
Broadband access is a key enabler of telehealth services and access to health information[8]. The COVID-19 pandemic accelerated the adoption of telehealth, even in medical fields that had previously not depended on it. Between March and May 2019, for example, Elevance Health’s affiliated Medicare Advantage plans recorded 4,400 virtual healthcare services. During the same period in 2020, adoption skyrocketed to 600,000[9].
Beyond healthcare, access to broadband internet is a social driver of health (SDOH) as it impacts various SDOH domains, including economic stability, education, food, employment, community and social context, and neighborhood and physical environment, which, in turn, have a direct impact on health outcomes[10],[11],[12]. For this reason, Bauerly (2019) describes broadband internet as a “super-determinant” of health[13].
Broadband interventions aim to expand internet access to populations lacking adequate connectivity, particularly in rural and underserved communities[14]. These interventions typically involve deploying infrastructure such as wireless networks that meet minimum broadband speed standards or installing fiber-optic cables[15],[16]. Implementation often requires partnerships between telecommunications providers, government entities, healthcare organizations, and community stakeholders and may be delivered at various scales, ranging from community-wide expansion projects to targeted programs serving specific households or populations[17].
Broadband interventions vary in scope and design. Some focus solely on infrastructure provisions, while others combine connectivity with supportive services such as digital literacy training or guidance on accessing health-related online resources[18]. Healthcare systems may implement broadband programs as part of broader telehealth initiatives, recognizing connectivity as a prerequisite for virtual care delivery[19]. Considerations during implementation include the target population's needs, existing infrastructure limitations, and available resources for implementation and sustainability.
Residents in Cornwall, a rural county in southwest England.
Implementation of broadband internet (Superfast). Participants enrolled in the groups receiving Superfast were supplied with the broadband infrastructure, including the necessary fiber optic cables, by the European Union, British Telecom, and Cornwall Council. This came at no cost to them, as part of an unrelated national expansion project.
Non-randomized trial. N = 1,388 in the initial randomization sample. 394 households responded at baseline, and 259 to the follow up survey.
Healthcare Cost, Utilization & Value: Electronic health (eHealth) readiness improved over 18 months from 4.36 out of 10 to 4.59 out of 10. However, there was no change in eHealth inequality, measured using the standard deviation in eHealth readiness scores. Of note, only three of 246 households responded to the follow-up survey that they “would use the internet more for health if I could get a good internet connection,” suggesting that very few perceived their current internet speed as a barrier to eHealth use.
Rural Medicare enrollees with inadequate access to primary care physicians (PCPs) and psychiatrists.
Sufficient access to broadband internet.
Observational study with a comparison group.
Healthcare Cost, Utilization & Value: Adequate access to PCPs and psychiatrists decreased in counties with extreme access considerations relative to rural counties. Within rurality categories, counties with inadequate access to PCPs or psychiatrists generally had poorer broadband penetration rates.
A national sample from the FCC fixed broadband data crosslinked to the Association of American Medical Colleges Consumer Survey of Health Care Access data for years 2014-2018.
Access to broadband internet.
Observational study with a comparison group. N = 23,131.
Healthcare Cost, Utilization & Value: Compared to urban residents with broadband access, rural residents without broadband access had 72% higher odds of reporting zero (none use) versus low (1-3) electronic patient engagement (EPE) activities. In contrast, odds were 58% lower for reporting high (4-6) EPE activities for rural residents without broadband access. Suburban and rural residents were 36% less likely to report 4-6 EPE activities compared with urban residents. Rural and suburban residents had 56% and 30% higher odds respectively of reporting zero EPE activity than urban residents. Broadband access was not significantly associated with the intensity of use. Suburban and rural residents were also significantly less likely to engage in each EPE activity than urban residents.
Veterans from primary care clinics providing telemedicine and in-person clinical visits before the COVID-19 pandemic (October 1, 2016, to February 28, 2020) and after the onset of the pandemic (March 1, 2020, to June 30, 2021) in the Veterans Health Administration).
The sample was 71.9% White and 91.8% male with a mean age of 63.9 years.
Access to broadband internet.
Observational study with a comparison group. N = 6,995,545.
Healthcare Cost, Utilization & Value: The increase in the rate of video visits before versus after the onset of the pandemic was greatest among patients in the lowest Area Deprivation Index (ADI) category (a measure of neighborhood socioeconomic disadvantage) with optimal broadband access compared to those with inadequate broadband. Veterans with the least neighborhood-level social disadvantage (lowest ADI tertile) had higher rates of video visits when comparing optimal with inadequate broadband availability. However, based on broadband availability, video visits did not differ among those living in neighborhoods of lower socioeconomic status (highest ADI tertile).
Medicare Fee-for-Service beneficiaries from January through September 2020.
Broadband access at the county level.
Observational study with a comparison group. N = 3,107 counties.
Healthcare Cost, Utilization & Value: Among the 3,107 counties, those with the greatest broadband availability (quintile 5) had 47% higher telehealth utilization compared to counties with the least broadband availability (quintile 1). In the adjusted model, a 1 standard deviation (SD) increase in broadband access was associated with a 1.54 percentage point (pp) increase in telehealth utilization (P < 0.001).
Rural county designation (−1.96 pp; P < 0.001) and 1 SD increases in average Medicare beneficiary age (−1.34 pp; P = 0.001), number of nursing home beds per 1,000 individuals (−0.38 pp; P = 0.002), and proportion of Native Americans/Pacific Islanders (−0.59 pp; P < 0.001) were associated with decreased telehealth utilization.
Original Medicare patients hospitalized between 2006 and 2014 for elective hip or knee replacements, emergency heart attacks or ischemic strokes (AMI/ST sample), or those with outpatient claims for colonoscopies.
Rollout of broadband internet.
Observational study with a comparison group.
Health: An increase in the number of broadband providers in a patient’s ZIP code was associated with a lower probability of readmission for joint replacement. Specifically, the readmission probability was 5.7% lower when a patient’s ZIP code shifted from having zero broadband providers to four or more.
There were diminishing marginal returns in readmission probability as the number of broadband providers increased, with the strongest improvements in outcomes observed when a ZIP code gained broadband internet providers after previously having none. Beyond four providers, additional gains in health outcomes were minimal.
Similar reductions in readmission probability were found for colonoscopies. The study found that patients in areas with broadband were less likely to receive care at hospitals with high readmission and mortality rates, suggesting that broadband access enabled patients to research and select higher-quality providers for elective procedures.
By contrast, broadband expansion was not significantly associated with patient outcomes following hospitalizations for emergencies such as AMI and stroke, where opportunities for patient choice are more limited.
Patients seen at least once in the outpatient clinics of a single integrated public health care system in Cuyahoga County, Ohio between 2012 and 2015. Patients who initiated portal use were 34.1% White, 23.4% Black, and 23.8% Hispanic/Latino.
Access to broadband internet.
Observational study with a comparison group. N= 243,248 patients.
Healthcare Cost, Utilization & Value: Broadband internet usage explained 68% of the variation in the use of the patient portal to send messages to providers. As the percentage of home broadband internet connections increased, so did the percentage of participant portal use (ranging from 17.5% to 34.8%).
A national prospective cohort of minority women earning lower incomes in the U.S. Data collection occurred from October 2014 to September 2015 in Chicago, New York, Washington DC, San Francisco, Atlanta, Chapel Hill, Birmingham/Jackson, and Miami. The sample was 74% Black and 15% Hispanic. 53% of the sample had ≤ $12,000 yearly income.
Daily internet use.
Observational study with a comparison group. N = 1,915.
Social: Participants with daily internet use reported a higher quality of life at six months.
Adults and children residing in Wolverhampton, United Kingdom who had contact with the health system.
The mean age of the sample was 38.6 years, and the sample was 50.4% male and 57.1% White.
Broadband provision, defined as the type, speed, and bandwidth quality and number of suppliers for broadband in defined localities.
Observational study with a comparison group. N = 269,785.
Healthcare Cost, Utilization & Value: Lower broadband provision was associated with a higher number of health comorbidities and more non-elective urgent events over 12 months.
Adult patients with one or more in-person or remote encounters in a health system in western Tennessee and residing in western Tennessee between March 13, 2019, and March 13, 2021 (N = 54,688).
Participants were predominantly White (79%), residing in rural ZIP codes (73%), with median household incomes ($52,085) less than state and national averages.
Access to the internet meeting the FCC definition of broadband.
Observational study with a comparison group. N = 61,521.
Healthcare Cost, Utilization & Value: The availability of broadband internet was one of many factors associated with the utilization of telemedicine. Patients residing in a ZIP code with 80 to 100% broadband access compared to 0 to 20% were more likely in the year following March 13, 2020 to have completed both telemedicine and in-person visits ([OR; 95% CI] 1.57; 1.29, 1.94), completed only telemedicine visits (2.26; 1.71, 2.97), less likely to have only completed in-person visits (0.81; 0.74, 0.89), but no more or less likely to have accessed no care (1.07; 0.97, 1.18).
A small rural community in Turney, Missouri considered underserved in terms of broadband access. Respondents were 54 years old on average, 90% were White, 56% were women, and 36% had completed a bachelor's degree or higher. 22% of the connected Turney participants and 56% of the unconnected Turney survey participants reported having a bachelor's degree or higher. The median household income was $35,000-$65,000 and the median age was 41 years old.
Access to free wireless broadband internet. Participants received free broadband service during the duration of the study (control participants did not receive free services). In addition, connected households received an email every two weeks highlighting local resources and training related to distance education, telemedicine, entrepreneurship, and other ways to leverage their new internet service.
Pre-post study, non-randomized control and qualitative study. N = 135 unique respondents across both surveys and all sub-samples.
Healthcare Cost, Utilization & Value: In a within-subject comparison, there were no significant differences in health internet use between the pre- and post-survey responses for Turney residents. Qualitative results indicate that more participants reported no change or did not respond to questions regarding health benefits, than reported benefits.
Social: In a within-subject comparison, there were no significant differences in employment and education internet use between the pre- and post-survey responses for Turney residents. However, qualitative data suggests that even though the effects were not statistically significant, participants perceived benefits of the new internet service on employment, education, and health. More participants reported benefits related to employment and education than health.
Nationally representative 20% sample of Medicare fee-for-service beneficiaries and data from OptumLabs.
The study sample consisted of 869 metropolitan counties with at least some rural residents, 1,317 nonmetropolitan counties with smaller towns/cities, and 599 fully rural counties.
Availability of broadband in local communities.
Observational study with a comparison group. N = 2,785.
Healthcare Cost, Utilization & Value: Broadband availability was associated with greater telemedicine use, but only in fully rural counties. Counties with low broadband availability had 34% fewer visits per capita compared with counties with high broadband availability (13.4 per 1,000 vs. 20.4). In metropolitan counties with rural residents, counties with low vs. high broadband availability had 2.4% more visits per capita (4.2 vs. 4.1 per 1,000).
The health inequality analysis uses an unbalanced panel of 83 countries with 272 country-year observations (1993–2019). The healthcare access analysis uses an unbalanced panel of up to 194 countries with 1,156 country-year observations (1990–2016).
Access to the internet.
Observational study with a comparison group.
Healthcare Cost, Utilization & Value: Higher internet access is associated with reduced health inequality, with a positive and significant effect on the Absolute Concentration Index (mean = −5.23, median = −4.68, p < 0.05). Internet access significantly lowers the infant mortality rate, with a 10% increase in access linked to a reduction of approximately 0.11 deaths per 1,000 live births (p < 0.01). The study also finds that Internet access improves healthcare access and mitigates the negative effect of income inequality, with this moderating effect being particularly pronounced in countries with higher levels of income inequality.
[1] US Census Bureau. (2024, June 18). Computer and Internet Use in the United States: 2021. Census.gov. https://www.census.gov/newsroom/press-releases/2024/computer-internet-use-2021.html
[2] Stepanek, L. (2025, January 14). About 85% of Americans Consider Internet a Utility and More New Stats: Report. Telecompetitor.com. https://www.telecompetitor.com/about-85-of-americans-consider-internet-a-utility-and-more-new-stats-report/
[3] Goldberg, R. (2024, June 6). New NTIA Data Show 13 Million More Internet Users in the U.S. in 2023 than 2021 | National Telecommunications and Information Administration. Ntia.gov. https://www.ntia.gov/blog/2024/new-ntia-data-show-13-million-more-internet-users-us-2023-2021
[4] Horrigan, J. (2025, June 18). Lessons From Broadband Adoption Trends. Benton Foundation. https://www.benton.org/blog/lessons-broadband-adoption-trends
[5] Stepanek, L. (2025, January 14). About 85% of Americans Consider Internet a Utility and More New Stats: Report. Telecompetitor.com. https://www.telecompetitor.com/about-85-of-americans-consider-internet-a-utility-and-more-new-stats-report/
[6] Goldberg, R. (2024, June 6). New NTIA Data Show 13 Million More Internet Users in the U.S. in 2023 than 2021 | National Telecommunications and Information Administration. Ntia.gov. https://www.ntia.gov/blog/2024/new-ntia-data-show-13-million-more-internet-users-us-2023-2021
[7] Neenan, J. (2024, March 14). FCC Increases Broadband Benchmark. Broadband Breakfast. https://broadbandbreakfast.com/fcc-increases-broadband-benchmark/
[8] Bauerly, B. C., McCord, R. F., Hulkower, R., & Pepin, D. (2019). Broadband Access as a Public Health Issue: The Role of Law in Expanding Broadband Access and Connecting Underserved Communities for Better Health Outcomes. The Journal of law, medicine & ethics: a journal of the American Society of Law, Medicine & Ethics, 47(2_suppl), 39–42. https://doi.org/10.1177/1073110519857314
[9] Anthem Public Policy Institute (PPI). (November 2020). Virtual healthcare use among Medicare Advantage members before and during the COVID-19 pandemic. Available at: https://www.elevancehealth.com/content/dam/elevance-health/articles/ppi_assets/42/42_report.pdf. Accessed on March 8, 2023.
[10] Allen, S. (2025). Broadband Internet Access as a Social Determinant of Health in the Early COVID-19 Pandemic in U.S. Counties. SSM - Population Health, 101747–101747. https://doi.org/10.1016/j.ssmph.2025.101747
[11] Benda, N. C., Veinot, T. C., Sieck, C. J., & Ancker, J. S. (2020). Broadband internet access is a social determinant of health!. American journal of public health, 110(8), 1123-1125.
[12] Bauerly, B. C., McCord, R. F., Hulkower, R., & Pepin, D. (2019). Broadband Access as a Public Health Issue: The Role of Law in Expanding Broadband Access and Connecting Underserved Communities for Better Health Outcomes. The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics, 47(2_suppl), 39–42. https://doi.org/10.1177/1073110519857314
[13] Bauerly, B. C., McCord, R. F., Hulkower, R., & Pepin, D. (2019). Broadband Access as a Public Health Issue: The Role of Law in Expanding Broadband Access and Connecting Underserved Communities for Better Health Outcomes. The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics, 47(2_suppl), 39–42. https://doi.org/10.1177/1073110519857314
[14] Drake, C., Zhang, Y., Chaiyachati, K. H., & Polsky, D. (2019). The limitations of poor broadband internet access for telemedicine use in rural America: An observational study. Annals of Internal Medicine, 171(5). https://doi.org/10.7326/M19-0283
[15] Abbott-Garner, P., Richardson, J., & Jones, R. B. (2019). The impact of superfast broadband, tailored booklets for households, and discussions with general practitioners on personal electronic health readiness: Cluster factorial quasi-randomized control trial. Journal of Medical Internet Research, 21(3), e11386. https://www.jmir.org/2019/3/e11386/PDF
[16] Valentín-Sívico, J., Canfield, C., Low, S. A., & Gollnick, C. (2023). Evaluating the impact of broadband access and internet use in a small underserved rural community. Telecommunications Policy, 47(3), 102491. https://www.sciencedirect.com/science/article/pii/S0308596123000101
[17] Valentín-Sívico, J., Canfield, C., Low, S. A., & Gollnick, C. (2023). Evaluating the impact of broadband access and internet use in a small underserved rural community. Telecommunications Policy, 47(3), 102491. https://www.sciencedirect.com/science/article/pii/S0308596123000101
[18] Valentín-Sívico, J., Canfield, C., Low, S. A., & Gollnick, C. (2023). Evaluating the impact of broadband access and internet use in a small underserved rural community. Telecommunications Policy, 47(3), 102491. https://www.sciencedirect.com/science/article/pii/S0308596123000101
[19] Drake, C., Zhang, Y., Chaiyachati, K. H., & Polsky, D. (2019). The limitations of poor broadband internet access for telemedicine use in rural America: An observational study. Annals of Internal Medicine, 171(5). https://doi.org/10.7326/M19-0283
