The short answer
Yes. Not everywhere, and less every year, but in some places a lot more than you would guess. It is less about old machines and more about who is on the other end. A government office, a payer or a hospital records department publishes a fax number, and the people who need something from them send faxes. Most of those faxes now leave a PC and arrive as a PDF. It is still fax.
Below are the numbers we could check at the source, country by country, then a list of figures that get repeated a lot and do not hold up. Every number has its source and year next to it. The full list is at the bottom.
Germany: three offices in four
Bitkom, the German digital industry association, has asked the same question since 2018. In early 2024 it phoned 604 companies with 20 or more employees. 77% still used fax (Bitkom, 2024), down from 82% in 2023, 88% in 2022, 92% in 2020 and 95% in 2018. One in four (25%) faxed often or very often, down from 49% in 2018 (Bitkom, 2024).
It is declining, slowly. Bitkom's own words: the change is happening erstaunlich langsam, surprisingly slowly. The reasons are worth reading, because they are not nostalgia (Bitkom, 2024, companies that fax):
- 56%: unavoidable with the authorities.
- 43%: safer than the post.
- 35%: the fax process works and is established.
- 27%: habit. Another 27%: they need a delivery confirmation.
And 72% of German companies that fax send at least some of it as fax-from-email, the "modern standard"; 24% use nothing else (Bitkom, 2024). The paper is going away faster than the fax is.
Japan: the schools and the ministries
Japan's education ministry (MEXT) set a goal of ending hanko seals and fax in schools, "in principle", by fiscal 2025. Its own self-check of 28,049 public elementary and junior high schools, published in March 2026, found 71.7% still using fax in daily work and 91.0% with documents that still need a seal (MEXT, 2026). The first round, in December 2023, had fax at 95.9% of schools. Most of it went to private suppliers (70%), boards of education (58%) and school-lunch centres (32%) (MEXT, 2023).
That is real progress, from 95.9% to 71.7% in about two years, and it is still most schools. The central government tried the same thing in 2021. After a June notice told ministries to stop faxing, the reform office received about 400 responses from officials arguing to keep it, many on security grounds (The Japan Times, 2021).
The UK: the NHS and its fax ban
In July 2018 the Royal College of Surgeons used Freedom of Information requests to count 8,209 fax machines in NHS hospital trusts in England. Newcastle upon Tyne had the most, 603 (RCS, 2018). Five months later the Health and Social Care Secretary banned the NHS from buying new fax machines from January 2019 and set 31 March 2020 as the date for removing them (DHSC, 2018). By September 2019, FOI replies suggested about 42% had gone (Healthcare IT News, 2019).
The NHS is the one large system here that tried to end fax by order, and it is the clearest example of how long that takes even with a deadline.
The US: healthcare, mostly
In a November 2019 MGMA poll, 89% of US medical practices said they used a fax machine (n=1,581). Their top uses were sharing records, referrals, labs and results, payers, and pharmacies (MGMA, 2019). The volume is widely reported as about 9 billion (2019) fax pages a year in US healthcare. We could not find the original measurement behind that figure, so read it as an estimate.
Prior authorization, where an office asks an insurer for approval, is the one place it is measured carefully. The 2024 CAQH Index found US medical prior authorizations were 35% fully electronic, 43% through payer portals and 22% fully manual. Fully manual means phone, mail, fax or email; CAQH does not split fax out. Fully manual was 33% in 2022 (CAQH, 2024). Each manual request took providers 24 minutes against 16 through a portal (CAQH, 2024). The same report notes a federal rule requiring insurers to offer electronic prior-authorization connections by January 2027 (CAQH, 2024, citing CMS).
So the trend is the same as Germany and Japan. Fax is shrinking where someone builds a working alternative on both ends, and staying where they don't.
The market: growing, by how much depends on whose report
You will see "the fax market is growing 13% a year" a lot. Here are two reports from the same research firm, side by side:
| Report | Size | Forecast | Growth a year |
|---|---|---|---|
| Verified Market Research, Online Fax Market | $4.18 billion (2024) | $12.52 billion (2031) | 13.06% |
| Verified Market Research, Cloud Fax Market | $559.4 million (2025) | $1.34 billion (2033) | 11.5% |
Same firm, similar subject, and the starting sizes are about seven times apart. Most of that is definition: what counts as "online" against "cloud", and whether consumer services are in. Both point the same way, up, by roughly 11-13% a year. Neither size should be quoted on its own as "the fax market".
For a hard number, the biggest listed fax company is a better guide than the analysts. Consensus Cloud Solutions, which owns eFax, reported about 638,000 small-office online fax customers and about 65,000 corporate customers in its annual report for 2025, roughly 703,000 in all (Consensus 10-K, 2025).
Numbers you've seen that don't hold up
This is the reason this page exists. The figures below show up again and again in articles about fax, usually without a link. We went looking for each one at its source. Some are real but from the wrong year. Some are much larger than what the company itself reports. Some we could not trace to anything.
| What you've read | What the source actually says | Year |
|---|---|---|
| The NHS still had 8,209 fax machines in 2019. | 8,209 is right, but it is the Royal College of Surgeons' count published in July 2018. By September 2019 about 42% of NHS fax machines had been removed (Healthcare IT News, 2019). | 2018 |
| In 2024, around 400 Japanese ministries objected to dropping the fax. | The Japan Times reported about 400 responses from officials after a June 2021 notice to stop faxing - in 2021, not 2024. | 2021 |
| 11 million businesses subscribe to eFax. | eFax's parent, Consensus Cloud Solutions, tells the SEC it serves about 638,000 small-office online fax customers and about 65,000 corporate customers - roughly 703,000 in all. | 2025 |
| Only 12% of 182 million prior authorizations are electronic. | 182 million comes from the 2018 CAQH Index. The 2024 CAQH Index puts medical prior authorization at 35% fully electronic, 43% through portals and 22% fully manual (phone, mail, fax and email together). | 2018 / 2024 |
| The fax market is growing 13% a year. | That matches one Verified Market Research report (online fax, 13.06%). The same firm's cloud fax report says 11.5% - for a market about seven times smaller. See the market section above. | 2024 / 2025 |
| 17 billion faxes are sent every year worldwide. | Attributed to Consensus, but not in its annual report to the SEC. We could not find a primary source. | - |
| IDC: 200 billion pages a year go through US fax machines. | We could not find an IDC publication that says this. | - |
| IDC: 82% of organisations saw their fax use stay the same or grow. | From a vendor-commissioned IDC survey of about 2017. The copy we could trace has been taken down. Old, and not checkable today. | c. 2017 |
| 63% of corporate legal departments still fax (ACC, 2019). | We could not find it in the Association of Corporate Counsel's 2019 Chief Legal Officers Survey material. | - |
| 70% - or 90% - of clinical communication in US healthcare is fax. | No primary measurement found. An older "75%" traces back to a 2017 news article, not a study. | - |
| 56% of referrals and 90% of medical record requests go by fax. | No primary source found. | - |
| The fax services market grew from $2.9 billion (2021) to $3.31 billion (2024) and will hit $6.5 billion by 2029. | Repeated without a report name. We could not tell whose forecast it is, so we cannot check it. | - |
| North America is 44-60% of the world fax market. | The one report we could read (Verified Market Research, cloud fax) puts North America at about 39%. | 2026 |
None of this means fax is fading faster than people say. Germany, Japan and US healthcare all show plenty of fax at the source. The numbers that hold up make the point well enough; the inflated ones aren't needed. If you have a primary source for any row above, send it to us and we will update the row and say so.
Where email wins (and where it doesn't)
We make a fax app, so here is the part a fax company usually leaves out. For most messages, email is better.
| Job | Which is better, and why | Winner |
|---|---|---|
| Cost per message | Email. Free to send; fax costs a line and, on most services, pages. | |
| Colour, photos, big files | Email. Fax is black and white at fax resolution; a colour photo arrives as a grey smudge. | |
| Back-and-forth | Email. Reply, thread, forward, cc. Fax has no thread. | |
| Finding it later | Email, out of the box. A fax is a picture until someone runs OCR on it. | |
| On your phone | Email. Most fax setups were built for a desk. | |
| Reaching a stranger's office | Fax. A fax number is printed on the form, the letterhead and the payer's website; nobody needs to give you an address or an account. | Fax |
| Proof it arrived | Fax, usually. The receiving machine answers and the sender gets a transmission result. 27% of German faxers say they keep faxing because they need that confirmation (Bitkom, 2024). | Fax |
| The other side requires it | Fax, because you have no choice. 56% of German companies that fax say they cannot avoid it with authorities (Bitkom, 2024). | Fax |
| Security | Neither, by default. Ordinary email can be read on any server it passes through; a fax can land face-up on a shared machine. Each can be done carefully. Neither is safe just because of what it is. | Tie |
Look at the right-hand column. Fax wins where the other office decides how you talk to them. Email wins everywhere else. That matches the reasons German companies gave Bitkom: authorities, delivery confirmation, and processes that already work.
Questions
- Is fax still used in 2026?
- Yes, in specific places. 77% of German companies with 20 or more staff still used fax in 2024 (Bitkom, 2024); 71.7% of Japanese public elementary and junior high schools used it in daily work in the latest ministry self-check (MEXT, 2026); and 89% of US medical practices told MGMA in 2019 that they had a fax machine.
- Which industries still rely on fax?
- Healthcare is the biggest: referrals, records, lab results, pharmacy and payer communication (MGMA, 2019). Government is the other driver - in Germany, communication with authorities is the most common reason companies keep faxing (56%, Bitkom 2024).
- How many fax pages does US healthcare send a year?
- It is widely reported as about 9 billion (2019). We could not find the original measurement, so treat it as an estimate.
- Is the fax market growing?
- Analysts say yes, but their sizes disagree. Verified Market Research puts online fax at $4.18 billion in 2024, growing 13.06% a year, and cloud fax at $559.4 million in 2025, growing 11.5% a year. The direction agrees; the size does not.
- Is fax more secure than email?
- Not automatically. Fax gives a delivery result and does not sit in a mailbox, but it can print on a shared machine. Ordinary email can be read on the servers it passes through. How you handle each one matters more than which you pick.
Sources
- Bitkom, "In 3 von 4 Bueros wird noch gefaxt", 17 June 2024 (604 companies with 20+ staff, phone survey, Jan-Feb 2024). https://www.bitkom.org/Presse/Presseinformation/3-von-4-Bueros-gefaxt
- MEXT, GIGA School Komu DX checklist self-inspection results, March 2026 (Japanese). https://www.mext.go.jp/a_menu/shotou/zyouhou/detail/mext_00085.html
- Resemom ReseEd, coverage of the March 2026 MEXT results (Japanese). https://reseed.resemom.jp/article/2026/03/11/12793.html
- Kyobun, coverage of the December 2023 MEXT results (Japanese). https://www.kyobun.co.jp/article/2023122703
- The Japan Times, "Phasing out faxes faces fierce resistance from Japan's bureaucrats", 9 August 2021. https://www.japantimes.co.jp/news/2021/08/09/national/fax-machine-phaseout-pushback/
- Royal College of Surgeons of England, NHS fax machines press release, 12 July 2018. https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/nhs-fax-machines/
- UK Department of Health and Social Care, "Health and Social Care Secretary bans fax machines in NHS", 9 December 2018. https://www.gov.uk/government/news/health-and-social-care-secretary-bans-fax-machines-in-nhs
- Healthcare IT News, NHS trusts and the axe-the-fax target (FOI), 2019. https://www.healthcareitnews.com/news/emea/nhs-trusts-risk-failing-reach-axe-fax-target-freedom-information-requests-reveal
- MGMA Stat poll, "Time warp: the lingering legacy of fax in medical practices", 5 November 2019 (n=1,581). https://www.mgma.com/mgma-stats/time-warp-the-lingering-legacy-of-fax-in-medical-practices
- CAQH, 2024 CAQH Index report (prior authorization, pp. 17-19). https://www.caqh.org/hubfs/Index/2024%20Index%20Report/CAQH_IndexReport_2024_FINAL.pdf
- Medical Economics, "CMS killed the fax for billing. Now do it for patient care.", 16 July 2026 (repeats the 9 billion estimate). https://www.medicaleconomics.com/view/cms-killed-the-fax-for-billing-now-do-it-for-patient-care-
- Verified Market Research, Online Fax Market (2024-2031). https://www.verifiedmarketresearch.com/product/online-fax-market/
- Verified Market Research, Cloud Fax Market (2025-2033, updated March 2026). https://www.verifiedmarketresearch.com/product/cloud-fax-market/
- Consensus Cloud Solutions, Form 10-K for fiscal 2025, SEC EDGAR. https://www.sec.gov/Archives/edgar/data/1866633/000186663326000004/ccs-20251231.htm
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