Access to healthcare is a fundamental right, but for many, it's not just about having healthcare available—it's also about being able to reach it. Unfortunately, transportation barriers have become a significant hindrance, causing individuals, especially those with lower incomes, to miss out on crucial medical appointments.

The Transportation Challenge

Public transit is the backbone of transportation for many people, especially those residing in urban areas or belonging to marginalized communities. However, access to public transit is not uniform, and this disparity in accessibility affects healthcare-seeking behavior. While the expansion of public transportation systems has demonstrated positive outcomes, particularly for those covered by Medicaid, the advent of telehealth services during the COVID-19 pandemic has provided an alternative, though not universally accessible solution.

The Study's Key Findings

Using data from the Urban Institute's Health Reform Monitoring Survey (HRMS) conducted in June 2022, the study delved into the impact of transportation barriers on healthcare access. Several significant findings emerged:

1. Transportation Barriers Leading to Missed Healthcare: Approximately 5 percent of nonelderly adults reported not receiving necessary healthcare in the past year due to difficulties in finding transportation. This issue was more pronounced among individuals with low family incomes (14 percent), disabilities (17 percent), public health insurance coverage (12 percent), and those without household access to a vehicle (13 percent).
   
2. Unequal Access to Vehicles: While 91 percent of adults reported having access to a vehicle, this figure dropped significantly among urban communities (81 percent), individuals with low family incomes (78 percent), those with disabilities (83 percent), and adults with public health insurance (79 percent) or no health insurance coverage (83 percent).
   
3. Public Transit Accessibility Matters: Adults without access to a vehicle living in neighborhoods with fair or poor public transit access were much more likely to forego needed healthcare due to transportation challenges (21 percent) compared to those with excellent, very good, or good neighborhood transit access (9 percent).
   
4. Importance of Self-Reported Measures: Interestingly, the study found that self-reported measures of neighborhood public transportation access were more predictive of access to healthcare than city-level transit scores based on distance to transit stops and transit service frequency.

Implications and Policy Considerations

The study underscores the pivotal role that public transportation plays in ensuring equitable access to healthcare, especially for those without private vehicles. Policymakers can leverage these findings to drive investments in public transit, ultimately leading to better healthcare access. Additionally, expanding transportation benefits within health insurance plans and maintaining telehealth services post-pandemic can further alleviate transportation barriers.

Conclusion

While access to healthcare services is crucial, it's incomplete without the means to reach them. Transportation barriers pose a significant challenge, disproportionately affecting disadvantaged populations. This study emphasizes the critical role that public transit plays in mitigating these barriers, advocating for policy changes that enhance accessibility and ultimately promote health equity.

When combined with services like Non-Emergency Medical Transportation (NEMT) and providers in this space, we can bridge the transportation gap and ensure that everyone has the opportunity to access the healthcare they need, regardless of their circumstances.


Resources:

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Gimie, Afnan M., Andrea I. Melgar Castillo, Daniel Mullins, and Jason R. Falvey. 2022. “Epidemiology of Public Transportation Use among Older Adults in the United States.” Journal of the American Geriatrics Society 70 (12): 3549–559.

Heaps, Wendy, Erin Abramsohn, and Elizabeth Skillen. 2021. “Public Transportation in the US: A Driver of Health and Equity.” Washington, DC: Health Affairs.

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Litman, Toff. 2020. “Evaluating Public Transportation Health Benefits.” Victoria, BC: Victoria Transport Policy Institute.

Long, Sharon K., Genevieve M. Kenney, Stephen Zuckerman, Dana E. Goin, Douglas Wissoker, Fredric Blavin, Linda J. Blumberg, Lisa Clemans-Cope, John Holahan, and Katherine Hempstead. 2014. “The Health Reform Monitoring Survey: Addressing Data Gaps to Provide Timely Insights into the Affordable Care Act.” Health Affairs 33 (1):161–67.

Musumeci, MaryBeth, and Robin Rudowitz. 2016. “Medicaid Non-Emergency Medical Transportation: Overview and Key Issues in Medicaid Expansion Waivers.” San Francisco: KFF. Accessed February 10, 2023.

Patel, Sadiq Y., Ateev Mehrotra, Haiden A. Huskamp, Lori Uscher-Pines, Ishani Ganguli, and Michael Barnett. 2020. “Trends in Outpatient Care Delivery and Telemedicine during the COVID-19 Pandemic in the US.” JAMA Internal Medicine 181 (3): 388–91.