1.
The Effects of the Expansion of Broadband in
Garfield County
Kristen Malloy, Will Barber, Nick Eisterer, Anmol Nuggehalli
Colorado State University Economics Capstone
Fall 2016

2.
Executive Summary
Garfield County, located in the northwest end of the state of Colorado, is a semi­rural
County with a population of 58,082 as of 2015. The County is known for its popular mountain
town destination, Glenwood Springs, which brings in an estimated $243 million in tourism per
year as of 2013 (Stroud). This County has experienced a three percent population growth (U.S.
Census Bureau), and with so many yearly visitors, the need for broadband is a growing concern
for Garfield and many other rural counties across the U.S.
Currently,​ ​18­40% (Colorado Department of Local Affairs)of Garfield County does not
have access to broadband. Most of the areas where broadband is available lie on the I­70
corridor. In the modern economy, much of the growth and appeal to move into an area depends
heavily on broadband access. Broadband brings in jobs, people, and connects the area with the
rest of the world allowing for positive economic change. When analyzing the current condition
of Garfield County and conducting a base analysis, the conclusion is that broadband access
would heavily benefit the large retiree population and booming healthcare industry was realized.
Upon beginning research involving the analysis of the industries that bring in the most
amount of income and jobs, mining was primarily seen as the biggest industry for this particular
County. However, upon closer inspection, it was noted that aside from oil and gas extraction,
mining jobs peaked around 2007 and have been declining ever since. Furthermore, oil and gas
extraction is not seen as being a sustainable industry for job growth in the future.
The two hospitals, located in Glenwood Springs and Rifle, are the primary hospitals of
the County. This leaves many of the more rural areas located far away from the hospitals forcing
residents to travel long distances to receive care. When inspecting the 2014 base industries,

3.
retirees made up 14 percent and regional services (which includes healthcare) made up 28
percent (Colorado Department of Local Affairs). Given the number of jobs relating to these base
industries, it is feasible to infer that healthcare could be developed further especially when it
relates to the retired population.

4.
Table of Contents
I. Introduction
II. Base Analysis
A. Current Economic Base
B. Future Economic Drivers
III. Assets
IV. Implications
A. Potential Uses of Telemedicine
B. Advantages of Broadband and Telemedicine
C. Economic Forecasts
V. Conclusion
Appendix
Works Cited

5.
I. Introduction:
In 2014, the University of Wyoming completed a study involving the effects of better
broadband access on home prices. The analysis indicated that “access to the Internet could
add $11,815 to the value of a $439,000 vacation house in Door County, Wisconsin”
(Knutson). As countries such as the United States continue to develop, access to broadband
becomes a need rather than a luxury. Surprisingly, especially within Colorado, many rural
counties continue to struggle with broadband access. The negative effects of slow internet
speeds go beyond home values and the ability to stream movies to homes. In fact, without
broadband, the county loses a valuable resource that stimulates economic and industry
growth. Garfield County, Colorado is one of many counties that struggles with this setback.
Upon analyzing the current economic base and identifying the assets the county could
contribute to taking full advantage of broadband, the effects broadband access would have on
the health and education services industry were determined to be one of the major possible
drivers of future economic growth and expansion.
II. Base Analysis
A. Current Economic Base
Garfield County has a diverse economy in a sense of where all the jobs are currently
coming from. Government, mining, tourism, households (specifically retirees), and regional
services account for the vast majority of the jobs that Garfield County has (refer to Appendix
Chart A.). According to the base analysis, these different sectors account for about 85 percent
of the jobs within the county.

6.
These several different base industries not only drive Garfield County's economy but also
export jobs to neighboring counties such as Eagle, Pitkin, and Rio Blanco. With the location
quotient (LQ) greater than the value of one for these industries, it is evident that our county is
better than being simply self­sufficient.
According to the base analysis, there are 2,764 government jobs in Garfield County,
accounting for about eight percent of the total jobs. These government jobs, including the
school districts within the county, are supplying jobs that can assist the general well being of
the county. A great example of a flourishing government industry “job driver” is the Grand
River Hospital located in Rifle, CO. This hospital provides for several jobs within Rifle while
also providing services to much of the towns around Rifle that are closer in proximity than
the hospital in Glenwood Springs.
Mining also accounts for a large amount of the jobs in Garfield County, contributing
2,145 jobs or six and a half percent of the total jobs offered. With an exceptional LQ value
3.9, the mining industry has been contributing to Garfield’s economy. That being said, the
mining industry could potentially face a decline in the near future. According to an article by
Charles Ashby in the Daily Sentinel, “Mining and logging employment growth has been…
bad” (Ashby). As far as potential economic growth is concerned, it is in the county's best
interest to focus on an industry with more economic potential. The residents of Garfield
County have also given some pushback concerning the mining industry. According to
another article in the Daily Sentinel by Dennis Webb, “residents are calling on Gov. John
Hickenlooper to intervene after state regulators approved a second… oil and gas pad”
(Webb).

7.
Tourism brings a fair amount of seasonal jobs into Garfield County's economy as well.
With Glenwood Springs located in the heart of the county, many residents outside of Garfield
frequently visit the town for attractions such as the hot springs, white water rafting, hanging
lake, and the Vaudeville. Even during a summer of major bridge construction in Glenwood
Springs, tourism has been on the rise compared to recent years. According to an article by
John Stroud in the ​Post Independent, “a good sign that tourism remains strong [during bridge
construction] is that the city’s lodging tax is still running nearly 8 percent ahead of last
year…” (Stroud).
B. Future Economic Drivers
Health and education services (a subset of Regional Center/National Services), which
make up 6.9% of jobs taken from the base analysis, and the government base, which makes
up 8.38% of jobs, proves to be a major contributor to Garfield County. According to the
Colorado Department of Local Affairs (DoLA), retirees, government, and regional services
collectively make up 55% of base industries within Garfield County.
Local government makes up a substantial portion of government jobs (refer to Appendix
Chart B.). Local government jobs include those associated with Grand River Hospital District
and the Colorado Mountain College (CMC) which provides education programs including
those relating to nursing and other health service related degrees and certifications.
Retirees also make up a significant portion of Garfield Base Industries at 14% and
experienced the largest increase in population from 2010 to 2014 occured for residents over
the age of 55 (Colorado Department of Local Affairs). Upon gathering that there is a growing

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demand for health services especially from the aging population, healthcare became the
main focus for possible expansion primarily driven by increased broadband access.
Garfield County has two major hospitals; Valley View Hospital located in Glenwood
Springs,CO and Grand River Hospital located in Rifle,CO. These hospitals are located on the
I­70 corridor about forty miles apart. Although their location may initially be viewed as
being accessible primarily for travellers passing through the County, many small
communities within Garfield north of I­70 are not conveniently located in close proximity to
these hospitals.
Aside from Mesa County, where ​ St. Mary’s Hospital and Regional Medical Center in
Grand Junction is located, surrounding counties prove to have lower location quotients for
healthcare which implies that they could benefit from increased access to healthcare services
provided by Grand River Hospital and Valley View Hospital within Garfield. In addition,
there is an abundance of small mountain communities located around the Garfield County
area in Eagle County, Rio Blanco County, etc. that rely on health care services provided by
Garfield hospitals. For example, in on the outskirts of Gypsum, CO in Eagle County, some
residents must travel over an hour to Valley View Hospital; the closest medical center.
Although the majority of residents are located closer to major towns within the County, it is
not uncommon to travel around 30 minutes to the nearest hospital.​ When analyzing the
location quotient of Garfield for health services compared to neighboring counties, it
becomes clear that Garfield is currently exporting their services with the exception of Mesa
County (refer to Appendix Chart C.). This indicates that surrounding counties could benefit
from healthcare advancements made accessible from long distances such as telemedicine.

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III. Assets
When identifying the assets of Garfield County it is necessary to look into both the
demographics of the County as well as the assets from the various companies involved in the
medical field. As far as the demographics go, there are three distinct assets in which the
County is able to pull from: population, the age distribution, and the overall education of
individuals compared to those from other counties within the state of Colorado.
The overall population of a county is a crucial asset in which many economic
improvements can be generated from. When comparing Garfield to other counties around
Colorado and its neighbors, there are a couple of things that jump out right away. The first is
Garfield seems to be around middle of the pack in terms of total population of the county.
However when looking at the percentage change from 2010 to the 2015 estimates, Garfield
begins to shine in comparison to its counterparts. Garfield is expected to have grown by 3%
in five years while the others are growing at a much slower rate, if any at all. Both Rio
Blanco and Moffat County are projected to have decreased in their populations. However, the
much larger county, Mesa, is growing at a measly 1.2% (refer to Appendix Chart D.).
A deeper look at the distribution of ages among the county’s population is extremely
important to developing a successful economic strategy. All four of these counties have two
similar traits in their distribution of age (refer to Appendix Chart E.). The first common trait
is that each county is expected to decrease in persons under the age of 18 from 2010 to 2015.
Although the total population of Garfield County is expected to of grown in that five year
period, the county is not producing more people from within. Rather, this growth in
population can be contributed, in part, to the influx of people from outside of the county and

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state. While on the other end of the spectrum, each county is expected to have an increase in
total persons over the age of 65. This increase in people over the age of 65 can be attributed
to an increase in Garfield becoming a more popular place for retirement for the ageing
generations, such as the Baby Boomers. As a result of these changes in the age distribution,
Garfield County has the unique opportunity to build off of its already existing hospitals in
Glenwood Springs and Rifle to address the ageing population in not only its own borders but
also in the surrounding counties.
Finally, an important part of the demographic for Garfield County is the education of the
people living within it (refer to Appendix Chart F.). A higher percentage in education can
only benefit the the county’s economic prospects. Looking at the percentage of each
county’s population with at least a high school education, Garfield does appear to fall behind
some of the surrounding counties, however that is not where Garfield County excels. It is in
the “Bachelor’s Degree or higher” category that Garfield County thrusts itself past other
counties in comparison. In other words, Garfield has a population that exceeds the base
education required to function well in society. Thus, it gives the county a distinct advantage
and asset in which it can further expand its economy outside of simply adding restaurant or
menial labor jobs.
As for assets outside of pure demographics, there are a number of different assets which
can help propel Garfield’s already successful medical field into a dominant economic driver
in the region. These assets include two rather large hospitals in Glenwood Springs and Rifle.
To be more specific, the Valley View Hospital in Glenwood Springs and Grand River in
Rifle. With that being said, the Valley View Hospital in its current location has a far greater

11.
advantage over Grand River. Valley View is the larger of the two hospitals in both current
size and potential growth. It is the location which truly makes it an advantage over the
surrounding counties in that it is able to be the focal point for much of the medical needs in
the mountainous region. This brings us to a point where it is crucial to mention yet another
asset for both the County and the Valley View Hospital. Valley View, partnered with Classic
Air Medical, began type of flight for life operations on April 25th, 2016 (Causey). This
agreement has opened the door for Valley View to become the dominant hospital in the
region by providing an alternative for emergency medical situations that would require
transport by ground in the past. This flight for life asset will allow for medical assistance to
be deployed in ten minutes and then only about an hour’s flight to Denver, a drive which can
take hours (Causey). This makes Valley View an extremely important factor medical
emergencies and an incredibly important asset for increasing Garfield’s economic standing.
Yet another asset already present in the county is Colorado Mountain College (CMC).
CMC not only provides traditional degrees such as business but also a number of degrees and
certificates in the medical field. According to the Colorado Mountain College website, these
degrees and certificates include EMT basic and intermediate certificates, Nurse Aid
certificates, Nursing AAS (Associate of Applied Science), and Nursing BSN (Bachelor of
Science in Nursing). With a college within the county which offers these various medical
degrees and certificates, Garfield does not need to export students elsewhere for education.
Rather, it can capitalize on this local asset pulling economic growth from both the college as
well as the surrounding hospitals. This college may also allow for closer work between the
college and hospitals which can lead to the developing of local assets and retaining these

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local assets rather than simply educating them and shipping them out of the County. To sum
up the importance of this asset, the college will provide a way to educate both the locals and
bring in a larger amount of young people to boost the growing population even more.
IV. Implications
Given the conclusion that the healthcare industry within Garfield is a growing economic
driver with room for continued growth with the introduction of broadband, we decided that
telemedicine will be the main implication derived from this expansion. Other implications
could include improved technology that could contribute to the Flight for Life portion of
Valley View Hospital, and the ambulances used at both hospitals. In this section, we will
discuss the potential uses of telemedicine, the possibility of exporting this service to
Garfield’s neighboring counties, and make forecasts on the local economies for the Garfield
County Region. The focus of our analysis will target the large retiree population, however we
may conduct analysis on other demographic groups.
A. The Potential Uses of Telemedicine
The first thing to remember is that healthcare delivery in rural areas is more arduous than
in metropolitan areas. The infrastructure in Garfield County at its current state is not
sufficient to effectively deliver healthcare to all residents. As a matter of fact, the only major
roadway throughout the County is the I­70 corridor extending from Glenwood Springs to
Parachute. As a result, a hub and spoke model would not be a solution. A 2003 study by
Michael Edwards and Arvind Patel highlighted this similar issue of geographic isolation in
Maine. Maine is similar in this aspect and has employed telemedicine alongside an integrated

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independent community health facilities network as a tool for health care delivery,
specifically targeting the elderly who cannot so easily transport themselves to a hospital
especially in regards to wintertime driving​ ​(Edwards and Patel). This is a similar situation in
Garfield County and some of the surrounding counties such as Eagle and Pitkin.
Telemedicine has an advantage in these types of situations regarding the nature of its location
neutral quality. Telemedicine is a relatively new medical field and it is expected to grow.
According to a Tractica report, in 2014 alone telemedicine conducted an approximate 19.7
million video consultations and by 2020 it is expected to grow at least by eight times more to
158.4 million​ ​(Businesswire). So what are the potential uses for telemedicine?
Telemedicine can assist in the delivery of healthcare and improve the quality of care. Its
uses can range from the live­tracking of emergency service vehicles to design more
time­efficient routes to geographic distant consults that reduce not only inpatient hospital
recovery time but also the number of follow­ups a patient has to undergo to be treated for
certain conditions. Another use telemedicine has is preventive care through giving the
population’s access to medical professionals so they are better informed of certain health
risks and how to manage those risks better​. ​For example, the risk associated with infant
mortality remains a relatively substantial problem within the United States. In the region that
includes Garfield, Eagle and Pitkin, the infant mortality rate is 4.9 percent and 8.4 percent in
the surrounding counties of Rio Blanco, Routt, and Moffat (Colorado.gov) (for further
reference to the infant mortality rates turn to Graphic H in the appendix).​ ​Valley View
Hospital’s new designation as a baby­friendly hospital in Glenwood Springs is a prime
example in how telemedicine can be used as a tool to expand its neonatal, prenatal, and

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postpartum services to those who cannot always directly come to the hospital to get the care
they need to ensure the babies’ and their mothers’ health​ ​(​Post Independent).
Telemedicine can also aid in the hospitals’ expansion of their patient base. As a matter of
fact, for Garfield the relative cost effectiveness of healthcare already is a pull factor for that
economic sector. According to a series of articles by the local newspaper, ​The Aspen Times,
people in Pitkin County are flocking to Glenwood Springs for healthcare due to the high
costs of healthcare in Aspen, CO (​Aspen Times). Telemedicine will increase access to the
healthcare for those not only living in Pitkin but also those who live in Eagle County where
they only have one major healthcare facility, which is modest in its delivery­of­care
capabilities. The same fact patterns hold true for the following counties of Routt, Moffat, and
Rio Blanco, where cost is not so much the issue as is the number of facilities, the burden the
large geographic area places on them, and the sparsity of their services and the residencies of
the greater community they serve; this is where telemedicine and the expansion of broadband
to increase its use can help improve the health of the counties’ residents (which will improve
the economy through human capital investments).
B. Advantages of Broadband and Telemedicine
We recently discussed the potential uses of telemedicine, implicitly advertising the
benefits of such a service in Garfield County. Now, we will discuss those advantages further.
We would like to reiterate the capabilities of the county for us to pursue this course of action
in expanding broadband with hopes to expand its telemedical capabilities.
Garfield County has invaluable assets to assist in increasing the access to healthcare and
its quality of care delivered. By this, we are more specifically referring to the two biggest and

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most comprehensive healthcare institutions in the county that serve not only the larger
communities of Garfield County but also those of Routt, Moffat, Rio Blanco, Eagle, and
Pitkin County. It is their pre­existing network of healthcare facilities that will allow
telemedicine to expand alongside in increasing access to healthcare and the quality of its
delivery as highlighted before. It will help doctors not only perform consults from a large
distance but also help patients be more able to keep follow­up appointments, physically
present or otherwise. This is not simply about a physical capital investment but also a human
capital investment that will improve the health of not only workers but business owners who
will work longer and produce more economic output because they are capable of doing so,
thanks to the increased access to and quality of healthcare. The increased access to healthcare
alongside its increase in quality of care delivered will allow the retiree population to be able
to invest more in their communities and their respective businesses over their remaining
lifetime. Telemedicine will help create money and increase output in those areas
geographically and within the peripheral markets. As for the other demographic groups, it is
possible that there will be outsiders who would be more willing to come into the hospital
towns and get proper health examinations and treatment which will increase the amount of
money produced in the county’s economy through its very own multiplier effect.
The other asset the county has is the Colorado Mountain College (CMC) which gives
training and education to potential workers in their counties. Hypothetically, if ten nurses
specifically trained to conduct appointments and other function via telemedicine, were hired
from CMC and they earn an average hourly wage of $36.25 and work an average of 50 hours
a week for the cost of $16,000 for each nursing student enrolled at CMC, we can estimate

16.
how much this would benefit the economy. Given the we have a multiplier of 1.6 for the
county in addition to the average salary of the nurses, we can expect that one nurse to
contribute approximately an additional $150,000 to the economy; if there were ten nurses
under the same model, they would contribute an additional $1.5 million. That is the very least
they could contribute to the county’s economy for a $16,000 human capital investment. CMC
can train and retrain nurses, PAs, and other medically certifiable workers in telemedicine and
basic medical care to assist the doctors in monitoring the health of their patients and
providing the basic care needed to ensure the patient lives a healthy life. Examples of this
include providing literature and lectures on the importance of diet and exercise to avoid the
escalation of cardiovascular health conditions and other related conditions such as diabetes.
The biggest selling point of telemedicine is the idea of preventive care or care that is given in
order to ensure patients don’t develop the serious conditions that could increase mortality
rates. Preventive care includes having the patient being informed about their individual
health and health concerns to having regular annual checkups and this the type of training we
are interested in allowing CMC to give to its students.
C. Economic Forecasts
Looking ahead, we see a foreseeable future for the telemedical industry. There is
potential for this industry to grow and we predict it will take at least ten years for this industry to
fully mature in its ability to achieve the standards at which telemedicine is hoped to be used. This
is a promising field of economic growth and a future driver of economic growth, given there are
optimistic expectations of economic performance both nationally and statewide, as the healthcare

17.
institutions gain more revenue and invest those profits from telemedicine back into growing and
expanding the telemedical network and capabilities.
Unlike mining, telemedicine will continue to grow and expand to its fullest potential with
a low likelihood of the industry declining especially given the increase in retirees within the
county. One reason why this is true is because we are selling a service and not a natural
resource­dependent good. Given population trends globally and statewide, let alone the county,
as more people come into the state and as the world continues to globalize with the help of
telecommunications technologies and their timely improvements, it is safe to say that
telemedicine will only increase directly proportionally with the population growth. In the
previous section, we did a simple money multiplier analysis of ten nurses with a 75th percentile
wage, according to the BSNedu website. The monetary benefits calculated will only continue to
grow with time and the expansion of this field of medicine, as the patient base grows
subsequently so will the employment numbers for this industry. Based on our research, we
believe that telemedicine will make Garfield County one of the leading counties of the Western
Slope in regards to healthcare services pulling in business from neighboring counties that will
also benefit from this industry expansion. This industry will bring jobs to these areas and allow
Garfield county to grow as an island economy through its exportation of telemedical services.
IV. Conclusion
We have conducted a base analysis of Garfield County’s economy and decided to further
inspect the healthcare services industry and how telemedicine could further boost that
industry and the local economy. Furthermore, we compared the analyses of Garfield county

18.
with other surrounding counties establishing a need for this service in the other counties
based on their location quotients and google searches of the hospitals present in that vicinity.
We identified assets that can assist in the advancement of telemedicine and boost the general
economy as a whole. Finally, we listed possible uses of telemedicine and the benefits it has,
and presented an argument in hopes of persuading the county to adopt this recommendation
of broadband expansion. Our scope to which telemedicine has been quite narrow yet also
wide enough to brainstorm ways to expand healthcare access. As we have stated before, we
believe that this industry expansion will result in large returns over the long run with minimal
costs to implement the virtual service. We believe that this recommendation will aid in
further developing this already growing county by enhancing broadband access and making it
accessible to all residents.

19.
Appendix
Charts
A.
B.
(demography.dola.colorado.gov­ Jobs by Sector: Garfield)

20.
C.
Location Quotient for Education and Health Services in Colorado in the
first quarter of 2016
Location Quotient Area Distribution Table
Area Location Quotient
Eagle County 0.48
Garfield County 1.12
Mesa County 1.22
Moffat County 0.57
Pitkin County 0.37
Rio Blanco County 1.09
Source: Labor Market Information, Quarterly Census of Employment and Wages Program
Downloaded: 09/12/2016 3:48 PM

21.
D.
County Population (2010) Population (2015
Estimate)
Garfield 56,389 58,095
Rio Blanco 6,669 6,571
Mesa 146,723 148,513
Moffat 13,795 12,937
(Data taken from ​http://www.census.gov/quickfacts/table/PST045215/08045​)
E.
County Age Under
18
(2010)
Age Under
18 (2015
Estimate
)
Age 65+
(2010)
Age 65+
(2015
Estimate
)
Garfield 27% 25.7% 8.4% 11.2%
Rio Blanco 24.3% 23.8% 12.4% 13.9%
Mesa 23.5% 22.3% 14.9% 17.4%
Moffat 27.1% 25.6% 10.5% 13.3%
(Data taken from ​http://www.census.gov/quickfacts/table/PST045215/08045​)

22.
F.
County High School or Higher
Education (2010 Ages
25+)
Bachelor’s Degree or
Higher Education
(2010 Ages 25+)
Garfield 85.3% 29.3%
Rio Blanco 91.2% 20.8%
Mesa 89.7% 25.2%
Moffat 89.1% 14.2%
(Data taken from ​http://www.census.gov/quickfacts/table/PST045215/08045​)
G.
(data taken from ​http://www.bsnedu.org/colorado­salary/​)

23.
H.
(graphic taken from
https://www.colorado.gov/pacific/sites/default/files/PW_ISVP_Infant­Mortality%20(1).p
df​)

24.
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25.
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<http://www.postindependent.com/news/valley­view­earns­baby­friendly­designation/>.

26.
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Websites Used:
Colorado Mountain College: ​http://coloradomtn.edu
Colorado Department of Local Affairs: colorado.gov