Greetings to the participants in the Transatlantic Telemedicine Summit. I am sorry not to be able to be with you in person. Your goal of increasing the development of telemedicine is one that is enthusiastically shared by the FCC and the United States.

Less than two weeks ago, on May 8, the FCC issued rules that put into place the single most important policy for encouraging the growth of telemedicine in the U.S. -- universal service.

I'd like to give you a sense of what universal service policy will mean to health care providers and patients in the United States -- and how this and other FCC policies will encourage the world-wide use of telemedicine.

Universal Service & Health Care

This is the first time universal service benefits have ever been specifically targeted to rural health care providers. Congress recognized that rural health care often suffers because of distance -- distance that can be overcome by telemedicine. About one quarter of the US population, over 60 million people, live in rural areas. The FCC's rules will directly link the 12,000 non-profit and public health care providers who serve rural Americans to specialists who would otherwise be hours or days away.

Universal service policy will save lives by saving time. In rural areas, trauma injuries are 4 times more likely to result in death than in urban areas due to distance and lack of information. Through universal service, rural health care providers will get support for telecommunications links that could reduce 50-fold the time needed to transmit an x-ray in an emergency situation and cut the charge as much as 10 times.

Congress saw that a big impediment to the use of telemedicine in rural areas was the very high cost of telecommunications services -- often several times the cost of similar services in urban areas. So it asked the FCC to figure out how to give public and non-profit rural health care providers access to advanced telecommunications services at rates comparable to those paid by their urban counterparts. Based on recommendations from our Advisory Committee on Telecommunications and Health Care, which were supported by a federal/state board of communications policy-makers, the FCC voted in favor of the following:

• Non-profit and public rural health care providers will be able to choose any level of transmission speed up to and including 1.54 Mbps (equivalent to a T-1) at rates comparable to those paid in urban areas. (They could choose a T-1, a quarter T-1, ISDN, a satellite connection, or any communications link of bandwidth equal to or less than 1.54 Mbps).

• Rates for these services will be made comparable through funding support for distance charges. Many telecommunications carriers charge a per-mile fee for their services. These distance charges make up the bulk of the difference between the telecommunications costs of rural health care providers and those of urban health care providers. Universal service funds will cover per-mile charges for a distance equivalent to that of the nearest city of 50,000.

• Universal service funds will cover a limited amount of toll-free access to the Internet. Some health care providers must make long distance calls to reach the nearest Internet service provider. For these health care providers, whether they are rural or urban, universal service will cover the lesser of $180 in toll charges or the amount of toll charges incurred for 30 hours a month to reach an Internet service provider. As you know, access to the Internet and its wide variety of health care information will provide new vehicles for consumer education. More than 50% of illnesses in the US, such as heart failure, lung cancer, and AIDS, can be traced to behavior patterns. The Internet will bring the most up-to-date information on disease prevention and treatment to rural populations via clinics and health centers. In addition, the Internet is extremely efficient for spreading information on regional health problems, such as epidemics of rabies or lyme disease, that frequently strike rural areas.

• There will be a total of $400 million per year available for universal service funding of telemedicine. This amount was based on an estimate of what it would cost if every one of the 12,000 eligible health care providers obtained universal service support for T-1 service and for toll-free access to the Internet. Whether the $400 million per year is reached will depend upon the number of eligible rural health care providers who apply for universal service support, and the types of services they choose.

International

The power of telemedicine is its ability to extend beyond geographical boundaries. By increasing the use of telemedicine in the US, we are increasing the quality of telemedicine available to any health care provider who has access to the Internet and other international information networks.

An example that many of you are familiar with of the potential of international collaboration in telemedicine is the work being done at Mass General Hospital. A magnetic resonance imaging scan of a patient in Saudi Arabia suspected of having a brain tumor can be scanned into a digitizer, compressed, and sent via telephone lines to Massachusetts. A radiologist at MGH reviews the image, and consults with a surgeon in Saudi Arabia.

Such exchanges save not only time and money but lives. The best thing the US can do to increase the growth of telemedicine throughout the world is to encourage the growth of competition in telecommunications.

We need competition in services between countries and between continents. Ultimately, we need competition in every country. Otherwise, monopolists will at minimum reduce the efficiency of the global network. At worst, when they are from large markets, they can leverage their monopoly at home into anticompetitive behavior in world markets.

The same principles of competition and deregulation that guided our own telecommunications reform legislation a year ago should guide the rest of the world in opening their telecommunications markets as we have. Over the past three years, we have worked to create the framework for a Global Information Infrastructure that will foster economic development for all countries of the world.

The FCC is preparing to play our appropriate role in implementing the World Trade Organization agreement that overthrows the monopoly paradigm in favor of the competition model in 69 countries around the world. The agreement is the best possible news for the world economy, and for the improvement of health care through telemedicine on a global scale.

I look forward to working with international leaders such as yourselves, in both the public and private sectors, to eliminate barriers to the spread of telemedicine. Among the most powerful contributions of this age of communications is the opportunity to improve the level of health care around the world.