Visualization of telemedicine in practice

Analysis of the potential economic benefits to Cherokee County, NC from increased broadband access and a telemedicine initiative reveals a complex interplay of factors. While calculating specific dollar amounts for such improvements in Cherokee County is not possible, there is a basis for a qualitative and quantitative estimation. Research published by The Federal Reserve Bank of Richmond has indicated that there are clear deficiencies when rural areas are compared to urban and semi-rural enclaves.

Qualitative Analysis:

• Economic Disadvantage and Need for Improvement: Cherokee County faces significant economic challenges, including high poverty rates, low per capita income (ranking 98th out of 100 counties in NC), and low average weekly wages (ranking 88th in the state). The county’s GDP also ranks near the bottom quarter of the state. Any economic boost could be impactful. Providing access for low income residents who are receiving county assistance, by means of a device and a service plan, might be cost effective. 
• Telehealth Potential in Rural Areas: Telehealth has the potential to improve healthcare access in rural areas, which often face shortages of healthcare professionals, specialists and hospitals. Cherokee County’s remote location and its distance from major metropolitan areas could make telemedicine a valuable tool for residents, reducing the need for long-distance travel for healthcare services. This benefit could only be realized through broadband access.
• Digital Divide is a Barrier: The “digital divide,” which is the disparity in access to broadband and digital devices between urban and rural communities, hinders the potential benefits of telehealth. Cherokee County’s broadband access is relatively low, with 79.2% of residents having access. It also ranks 41st in the state for access to computing devices. These statistics indicate a need for improvements to enable increased telehealth usage. There are homes where the family simply cannot afford a service plan, but there are also a significant number of homes where service is simply not available at all.
• Social Determinants of Health: Increased broadband access can lead to improvements in areas such as education and community engagement. Improving digital literacy can facilitate job creation. Increased access to opportunity creates better access to services and often leads to economic stability.
• Aging Population and Healthcare Needs: Cherokee County has the second-oldest population in North Carolina, which will likely mean an increased need for healthcare services. Telemedicine could provide convenient and cost-effective access to healthcare for elderly residents, allowing them to receive some components of care without travel to a doctor’s office.
  

  Counties included in Federal Reserve Bank of Richmond research Oct 2024

Quantitative Estimation:

• Broadband’s Economic Impact: A study in Harlan County, Kentucky, found that improved broadband could generate $71.5 million in direct economic benefits. This figure is for a county with distinct economic challenges, yet it is similar to Cherokee County in some ways. This figure indicates that significant economic benefits are possible through improved broadband infrastructure and digital adoption. The Harlan County study found that improving broadband infrastructure availability could lead to $8.7 million in economic benefits, while following up and increasing the adoption of online services might lead to a further $5.6 million benefit. That study also estimated that improved broadband availability could result in over 1,000 people either re-locating or staying in the county, resulting in an additional economic impact of $57.2 million. Although that final computation is compelling, it is also highly speculative. Proposing such results in Cherokee County is likely overly optimistic.
• Telehealth Usage: Telehealth usage increased significantly during the COVID-19 pandemic. During 2020 telemedicine interactions comprised 24% of all ambulatory care, compared to just 0.3% in 2019. As of June 2024, telehealth comprised nearly 5% of all medical insurance claims in the United States. However, rural populations are still 42% less likely to use telehealth services. Addressing the digital divide may lead to increased telemedicine usage in Cherokee County, and improved health outcomes could follow.
• Specific Data for Cherokee County: It is not possible to provide specific economic benefits data related to increased broadband access and telemedicine for Cherokee County. However, the county’s low ranking in GDP, per capita income, and average weekly wage, along with its high poverty rate, indicates significant room for improvement.
• Farmworkers and Broadband Access: Farmworkers in North Carolina have limited access to the internet, despite the increasing importance of internet access for health and socioeconomic well-being. The majority of farmworkers use cellular networks for access, and many do not have service robust enough to interact with online video. A portion of citizens in Cherokee County are in a similar dilemma. Increased availability and access for these people, who rely solely on cellular service, may also yield benefits.

Estimation of Economic Benefits

While a precise dollar figure for Cherokee County cannot be calculated, several points allow us to make a reasonable appraisal of the possibilities.

1. Significant Economic Improvement Potential: Given Cherokee County’s current economic status, there is a high potential for significant economic improvement through continuing to expand broadband networks.
2. Qualitative Benefits: The qualitative impact of increased broadband access on the population of Cherokee County is likely to include improved education, increased civic engagement, greater access to jobs, as well as better access to healthcare.
3. Quantitative Impact: Considering the Harlan County study and acknowledging Cherokee’s similar rural characteristics, it is plausible to estimate that Cherokee County could experience a multi-million dollar economic benefit from improved broadband and telehealth. This benefit would likely be seen across multiple sectors beyond healthcare, including education and workforce development.
4. Telemedicine Cost Reduction: It is important to note that improved telemedicine implementation will reduce costs and improve efficiency by reducing travel and waiting times, while improving access to specialized providers for residents within the county.
5. Need for Targeted Interventions: Research on farmworkers in North Carolina highlights the need for targeted interventions to improve internet access and digital literacy. These findings can inform county broadband infrastructure development to address the particular needs of specific population segments in Cherokee County. Families that are already receiving assistance from the county could be the first group to receive priority consideration.

It is important to note that no specific information about how much a further expansion of broadband could cost in Cherokee County is known. These costs would need to be considered in any real-world effort to determine any potential positive outcome. Even so, a potent combination of qualitative and quantitative aspects suggests that ongoing development of broadband infrastructure, followed by intentional telemedicine deployment, would produce tangible results. 

These consequences would just begin with healthcare, and likely include improved overall access to services in general, enhanced economic development, improved education outcomes, and higher levels of civic and social engagement.