Transportation and Health Care Access
Health care can be defined as the response to illness or disease in individuals. It encompasses diagnosis, treatment, and care for individual patients across health care settings (hospitals, health systems, physicians’ offices, clinics, rehabilitation facilities, nursing homes, etc.). Transportation plays a key role in ensuring individuals have access to the health care they need, when they need it.
What is the Model for Health Care Delivery in the United States?
Health care services are paid for through a mix of public and private, for-profit and nonprofit insurers and health care providers. On the public side, the Medicare program covers costs for adults age 65 and older and some people with disabilities, veterans and low-income people. Medicaid, a safety net program funded jointly by the federal government and states, covers costs for those who meet low-income levels. Medicaid programs are managed directly by each state under the oversight of the Centers for Medicare and Medicaid Services (CMS). States determine who and what type of services will be covered in their programs; as such, one person whose income is at 200% of the U.S. poverty level may be eligible in one state but not in another. Private insurance, the dominant form of coverage, is provided primarily by employers.
The United States spends more on health care services than does any other developed nation; the main drivers of these costs are estimated as 33% for hospital care, 25% for professional office-based services, 13% for long-term care, and 9% for prescription drugs. Two factors in the cost of health care are frequency of usage and the fee-per-service form of reimbursement. Looking at frequency, a small proportion of the health care-seeking population—approximately 5% in one study–accounts for the majority of health expenditures.
In another study, those who reported excellent health incurred an average of $2,350 annual for health care costs versus $26,450 for people who reported being in poor health. Thus, to lower health care expenditures in the United States, we need to improve the health status of those who have chronic health conditions and make the highest use of health care services, sometimes called the “superusers,” and reduce the frequency with which they need to access services.
Fixing the 5 Percent – The Atlantic
“Super-users” with complex medical needs make up a small fraction of U.S. patients, but they account for half of the nation’s overall health-care spending. Now, innovative efforts are providing better care at lower costs.
A second factor is the fee-for-service reimbursement model. Health care providers operate as a business, within a competitive environment, driven partially by market forces and to a larger degree by current reimbursement models. Basically, if they don’t provide services, they don’t get paid. While many in the health care sector care about and support improved health and well-being, they may resist implementing changes in the way they deliver health care, including the value-based approach that do not appear to have a favorable revenue component.
How does transportation intersect with health care?
Health care and transportation intersect where transportation is an essential service for getting people to primary care and preventive services as well as to post-hospitalization visits. When patients successfully access the health care provider visits, therapy destinations, and pharmacies, they have a better chance of remaining healthier and avoiding costly hospitalizations. Having transportation to these prevention-related destinations also reduces the use of expensive emergency services, such as ambulances and emergency departments. Thus potential partners in the health care space can include local hospital systems, health care insurers, state Medicaid departments, and local health care providers.
To address the issues of access to medical care, some transportation providers it are partnering with health care systems. Health care systems are even eligible to help pay for transportation access, as long as that financial assistance meets several criteria set out by the U.S. Department of Health & Human Services.
For further investigation . . .
Impact of Transportation Interventions on Health Care Outcomes: A Systematic Review
This systematic review synthesizes existing research on nonemergency medical transportation interventions. Eight studies met all inclusion criteria.
Transportation Barriers to Health Care in the United States: Findings From the National Health Interview Survey, 1997–2017
This study documents a significant problem in access to health care during a time of rapidly changing transportation technology.
A systematic review of interventions to minimize transportation barriers among people with chronic diseases
This study synthesized evidence concerning the types and impact of interventions that address transportation to chronic care management.
Needham Community Council – Needham, MA
In 2017, the Needham Community Council began supplementing its volunteer driver medical transportation program with trips provided through the ridehailing company, Lyft. Lyft rides were funded through the Needham Community Council operating budget and a donation from Beth Israel Deaconess Hospital – Needham.
Cape Cod Regional Transit Authority – Hyannis, MA
To promote access for Cape Cod residents to specialty medical appointments in Boston, the Cape Cod Regional Transit Authority (CCRTA) has run a Boston Hospital shuttle since 2001. The shuttle starts on the Outer Cape and picks passengers up at seven stops in different Cape towns, and then drives into Boston and drops passengers off at their appointments. In the early afternoon, the shuttle picks riders back up for the return trip to the Cape. Prior to the pandemic, service ran one daily round trip five days a week; since the pandemic, the shuttle runs Monday through Thursday. In order to serve as many residents as possible, the shuttle is open to the general public.
Explains how states can use untapped funding options under the Affordable Care Act to expand services for targeted low-income populations
Transportation Barriers to Health Care in the United States: Findings From the National Health Survey
This American Journal of Public Health article quantifies the number of people in the US who delay medical care annually
The Hidden Risk of Cutting Medicaid NEMT: An Examination of Transportation Service Interdependency at the Community Level
This report unpacks the interdependency between the provision of Medicaid NEMT and local public transportation. It uses case studies of