BOX 5.3Federal Programs That Support Health-Related Access to the Internet

Rural Health Care Program

The Universal Service Administration Company (USAC) supports Internet access for health care providers through the Rural Health Care Division (RHCD, formerly Rural Health Care Corporation), which was formed to ensure that health care providers in rural areas obtain the benefits of current telecommunications technology. The Universal Service Support Program established a fund of up to $400 million annually to ensure that rural health care providers pay no more than their urban counterparts do for telecommunication services, including Internet access. In particular, the RHCD aims to provide support to rural health care providers for services related to the delivery of telemedicine. Initially, the RHCD expected thousands of physicians to apply for this program. For a variety of reasons, however, the program has not been as successful as counterpart programs that support schools and libraries. In 1999, the RHCD approved and funded the first applications for physician access to the Internet through this program. On May 2, 1999, the Federal Communications Commission established $12 million as the collection level for the second funding year of the RHCD support program (July 1, 1999, to June 30, 2000). As of October 1999, the RHCD had committed total funding of only $1.2 million to 223 rural health care providers (USAC, 1999).1 Although the FCC modified the collection level, it did not revise the $400 million annual cap for the rural health care support mechanism. Among their drawbacks, the RHCD programs support Internet access by physicians but not mid-level practitioners or allied health professionals. Furthermore, the application process is burdensome, certain telecommunications companies are excluded from participation, and the program does not underwrite bandwidth above T-1 capacity. Without changes, the RHCD program cannot possibly meet its intended goals.2

Technology Opportunities Program3

The Technology Opportunities Program (TOP) is a competitive, merit-based grant program run by the U.S. Department of Commerce's National Telecommunications and Information Agency. The TOP provides matching grants to nonprofit organizations such as schools, libraries, hospitals, public safety entities, and state and local governments. The grants are intended to fund projects that improve the quality of, and the public's access to, health care, education, public safety, and other community-based services. The funds can be used to purchase networking equipment, including computers, videoconferencing systems, network routers, and telephones; buy software for organizing and processing all types of information, including computer graphics and databases; train staff, users, and others in the use of equipment and software; purchase communications services, such as Internet access; evaluate the projects; and disseminate the project's findings.

From its inception in 1994 through October 1999, the TOP had awarded 421 grants totaling $135.8 million and leveraging $203 million in local matching funds. Many grants supported projects in rural areas. Sixty-six of these grants, totaling $25 million in funding, supported health-related projects, ranging from efforts to develop a digital, wireless home health care service network, to the coordination of responses from health and emergency services to high-risk patients in the Pine Ridge Reservation, to the creation of a network linking 11 county health departments in California, through videoconferencing and data communications. Nevertheless, the TOP has been able to fund only a small percentage of the proposed projects. More than 5,300 grant proposals were submitted between 1994 and 1998, requesting $2.1 billion in funds; only 378 of these proposals were funded, using $188 million in federal funds.

Distance Learning and Telemedicine Grant and Loan Program

The U.S. Department of Agriculture's Distance Learning and Telemedicine Grant and Loan Program (DLT) was established to encourage, improve, and make affordable the use of telecommunications, computer networks, and related technologies for rural communities to improve their access to educational and/or medical services. The DLT helps rural schools and health care providers invest in telecommunications facilities and equipment to bring in educational and medical resources that might not otherwise be available in rural areas. Demand for the DLT has been high. Approximately 500 rural medical facilities will access improved medical care through linkage with other rural hospitals and urban medical centers for clinical interactive video consultation, distance training of rural health care providers, management and transport of patient information, and access to medical expertise or library resources.

The program is intended to fund projects that deliver critically needed educational and medical services in rural areas through structured, interactive educational training and/or medical professional presence over distance. It facilitates the networking of multiple sites dispersed over a large area rather than single, standalone entities. The DLT covers capital costs of acquiring and installing telecommunications hardware at schools, hospitals, and other eligible sites. It also covers other nonrecurring capital costs of establishing a distance learning and telemedicine system; software, training, and technical assistance are among the items that may be purchased. Funded projects are required to become self-sustaining through mechanisms such as user fees, tax assessments, or school budgets. Fifty-two grants totaling $13 million were awarded in 1999.


Detailed information on the awards is available online at <http://www​>.


Presentation by William England, Director of Operations & Systems, Rural Health Care Program, Universal Service Administrative Company, at the Emerging Health Information Infrastructure Conference (HII99), April 27, 1999, Washington, D.C.


The Telecommunications and Information Infrastructure Assistance program was renamed the Technology Opportunities Program in January 2000 to reflect the opportunities new technologies provide for economic advancement.

From: 5, Issues for Public Policy

Cover of Networking Health
Networking Health: Prescriptions for the Internet.
National Research Council (US) Committee on Enhancing the Internet for Health Applications: Technical Requirements and Implementation Strategies.
Washington (DC): National Academies Press (US); 2000.
Copyright © 2000, National Academy of Sciences.

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