Access to Cars Save Lives and Money in Healthcare

Let’s face it. Going to the doctor is an inconvenience for most of us. Sometimes it takes an entire workday to go to the doctor because of long wait times or because the doctor’s office is closer to our home rather than our workplace. If we cannot take the day off, then we must do a bit of planning to go to work, run to the doctor’s office, run back to work, and make it home at a reasonable time. It’s no wonder why the majority of Americans choose to drive to the doctor if they can. Unfortunately, many Americans don’t have access to reliable transportation, which has been costing the American healthcare system, both medically and financially.

In Part One of our multi-part series titled: Reasons People Don’t Go to the Doctor, we will explore the financial burden of missing a doctor’s appointment, who are more likely to miss a doctor’s appointment because of access to vehicles, and what solutions are being done to improve patient outcome and financial relief for both patients and healthcare system.

How Many Patients Miss Their Doctor Appointments?

Every year 3.6 million patients miss their medical appointments because of transportation barriers, according to a study published in The Gerontologist. Patients missing medical appointments can have a compounding effect on the healthcare system. For example, atenahealth looked at more than 3.5 million visits by 1.2 million patients at 1,626 primary care practices in a two-and-a-half period. Each “visit” included no-shows, cancellations, rescheduled, and kept appointments. They found that patients who failed to keep just one appointment with their primary care doctor were 70% more likely not to return within 18 months.

How Do Missed Appointments Cost Americans?

Missing one medical appointment can be the difference between diagnosing dangerous cancer early versus finding cancer too late. It’s the difference between maintaining control of your diabetes versus losing control of diabetes.

On the financial end, late diagnoses are expensive. The World Health Organization (WHO) released figures suggesting that “studies in high-income countries have shown that treatment for cancer patients who have been diagnosed early are 2 to 4 times less expensive compared to treating people diagnosed with cancer at more advanced stages.” This is because early-stage cancer treatments are prone to be more effective, less complicated, and thus less expensive.

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Just like how restaurants lose money by people missing on their reservations, hospitals and clinics miss out on opportunities to treat more patients when one patient misses an appointment. One study found that no-shows cost the United States’ healthcare system more than $150 billion per year. Individual physicians lose about an average of $196 per unused time slot. Treatments are cheaper and more effective on the patient, the hospital, and insurance companies when the patient and doctor have frequent and reliable access to each other.

Socioeconomic Status and Vehicular Access

In general, people of lower socioeconomic status are less likely to have access to a vehicle than people of higher socioeconomic status. A literature review by Samina Syed et al., published in the Journal of Community Health, reviewed nine studies to investigate the relationship between vehicular access and access to healthcare. They defined vehicular access as the patient owning a vehicle themselves or having access to a car through a family member or friend. All the studies suggested that increased access to a car was positively correlated with the increased access to healthcare.

Urban vs. Rural Vehicular Access

One study published in The Journal of Rural Health analyzed the relationship between access to transportation and the frequency of health care checkups in rural western North Carolina counties. The study found that patients who had a driver’s license had 2.3 times more health care visits for chronic care and 1.9 times more visits for regular checkup care than those who did not. Also, the study investigated what happens when patients have family or friends who could provide transportation. Those patients had 1.58 times more healthcare visits for chronic illnesses than those who did not. Those with a vehicle were more likely to visit medical care than those having to use public transportation. Those who used public transportation to seek medical care were more likely to visit a doctor than those with no public transport and no vehicular access.

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In urban areas like Atlanta, a study was published by Rask et al. surveyed 3,897 urban, low socioeconomic status patients suggested that having to walk or use public transportation to seek regular medical attention was an independent predictor for patients not seeking care. Also, the study found that patients with no vehicular access were more likely to wait more than two days before attempting medical care.

Racial and Ethnic Disparities on Vehicular Access

We can see racial and ethnic disparities for access to vehicles. According to the National Equity Atlas, minorities are less likely to have access to a car, especially in highly urbanized cities like New York, Newark, and Jersey City compared to smaller towns out West and South like Henderson City, Nevada and Plano, Texas.  Guidry et al. reviewed 593 survey responses of patients who had been clinically diagnosed with breast, colon, cervical, or prostate cancer, or lymphoma between 1989 and 1993. The research found that 38% of whites, 55% of African Americans, and 60% of Hispanics stated that reduced access to a vehicle was a significant barrier to cancer treatment. Black and Hispanic patients reported that barriers such as distance and access to a car were the most prominent barriers despite white patients having to travel farther to the facilities.

The Elderly Have Vehicular Access Issues

One of the biggest and often forgotten groups that have consistent vehicular access barriers is the elderly. These patients face an eclectic combination of transportation barriers because of their increased need for frequent doctor visits because of compounding health issues relative to other age populations. A report in The Atlantic discussed how 83-year-old patient Edith Stowe relies on buses to get regular checkups for chronic kidney failure twice every three months despite living only five miles from the hospital. If her appointment was scheduled in the middle of the day, then it takes her at least an hour to get to the hospital and an hour to get home using the bus. This resonates with many other studies suggesting that 3% to 21% of the elderly report that transportation barriers prevent them from accessing healthcare.

Do Ridesharing Companies Like Uber and Lyft Improve Vehicular Access?

Ridesharing companies like Uber and Lyft have sought to help address this $150 billion problem. Uber created Uber Health which is currently being used by more than 100 healthcare organizations in the United States and has become part of the beta program from centers like Adams Clinical, Blood Centers of the Pacific, Georgetown Home Care, LifeBridge Health, MedStar Health, Manhattan Women’s Health, NYU Perlmutter Cancer Center, Pro Staff Physical Therapy, ProActive Work Health Services, Project Open HandRenown Health, Thundermist Health Center and Yale-New Haven Health. Healthcare technology companies like Bracket Global and Collective Health are also exploring ways that Uber Health can work with their offerings.

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Since 2016, Lyft has expanded its network to broaden access to non-emergency medical transportation (NEMT). As of April 2020, Lyft works with three Medicaid agencies in Florida, Indiana, and South Carolina. Also, they provide access to rides for eligible Medicaid patients in 10 states plus the Washington D.C., giving access to potentially 22 million patients.

Currently, the results are mixed on the question if ridesharing companies help improve vehicular access. A 2018 Penn Medicine study, published in JAMA Internal Medicine, conducted a clinical trial of ridesharing interventions between October 2016 and April 2017. The study suggested that offering free Lyft rides to Medicaid patients for upcoming medical appointments was less than promising. They found that the missed appointment rate for patients offered a free Lyft ride, and those not offered a ride was practically the same: 36.5% vs. 36.7%.

On the other hand, Hennepin Healthcare in Minneapolis used Lyft rides to patients in need. Their pilot program reduced no-shows by 27% and increased the clinic’s revenue by an estimated $270,000 (ROI of 297%). Boston Medical Center used Uber Health to move their outpatients. They reported having greater patient satisfaction while saving $500,000 by replacing shuttle busses between main campuses and clinics.

Are There Supplemental Programs That Hospitals Provide?

Some medical centers and clinics try to bring doctors and resources to the patients at most risk of no vehicular access via mobile health clinics. A mobile health clinic can be defined as a regular doctor’s office or examination room located inside a large van or vehicle. CalvertHealth Medical Center has a Mobile Health Center that provides primary and preventive care services to patients undergoing transportation barriers. A 2017 literature review published in the International Journal for Equity in Health suggested that mobile health clinics helped patients in underserved areas access a doctor while the clinics receive a profit. The operational cost of the 2,000 mobile health clinics that are running is $429,000 annually. While serving 6.5 million mobile health clinic visits each year, the return on investment is approximately $12 per patient.

Hospital van programs in rural areas have helped increase access to medical care via transportation. For example, Taylor Regional Hospital operates a hospitality van service for patients in Taylor County and three neighboring counties. The hospital serves approximately 110,000 people in the rural community of Campbellsville, Kentucky, and surrounding regions. Jane Wheatley, CEO of Taylor Regional Hospital, discusses the van services and says, “With 25,000 people using this service, we’ve never received a negative comment or complaint about it. Patients themselves and their loved ones have expressed how helpful this service has been in receiving treatment.”

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In Summary

Implementing new strategies to help decrease the number of no-show medical appointments can increase both revenue and positive patient outcomes. Although physicians are more likely to live and work in areas of higher affluence, companies are working to help patients at risk of not access a doctor due to transportation access.

MacLeod, K. E., Ragland, D. R., Prohaska, T. R., Smith, M. L., Irmiter, C., & Satariano, W. A. (2015). Missed or delayed medical care appointments by older users of non-emergency medical transportation. The Gerontologist55(6), 1026-1037. doi: 1093/geront/gnu002

 

Hayhurst, C. (2019, May 15). No-show effect: Even one missed appointment risks retention. Retrieved August 09, 2020, from https://www.athenahealth.com/knowledge-hub/financial-performance/no-show-effect-even-one-missed-appointment-risks-retention

 

Early cancer diagnosis saves lives, cuts treatment costs. (2017, February 3). Retrieved August 16, 2020, from https://www.who.int/news-room/detail/03-02-2017-early-cancer-diagnosis-saves-lives-cuts-treatment-costs

 

Gier, J. (2017, May). Missed appointments cost the U.S. healthcare system $150B each year. Retrieved August 09, 2020, from https://www.scisolutions.com/uploads/news/Missed-Appts-Cost-HMT-Article-042617.pdf

 

Kheirkhah, P., Feng, Q., Travis, L. M., Tavakoli-Tabasi, S., & Sharafkhaneh, A. (2015). Prevalence, predictors and economic consequences of no-shows. BMC health services research16(1), 1-6. doi: 1186/s12913-015-1243-z

 

Syed, S. T., Gerber, B. S., & Sharp, L. K. (2013). Traveling towards disease: transportation barriers to health care access. Journal of community health38(5), 976-993. doi: 1007/s10900-013-9681-1

 

Arcury, T. A., Preisser, J. S., Gesler, W. M., & Powers, J. M. (2005). Access to transportation and health care utilization in a rural region. The Journal of Rural Health21(1), 31-38. doi: 1111/j.1748-0361.2005.tb00059.x

 

Rask, K. J., Williams, M. V., Parker, R. M., & McNagny, S. E. (1994). Obstacles predicting lack of a regular provider and delays in seeking care for patients at an urban public hospital. Jama271(24), 1931-1933. doi:1001/jama.1994.03510480055034

 

Car Access: National Equity Atlas. (n.d.). Retrieved August 09, 2020, from https://nationalequityatlas.org/indicators/Car_access

 

Guidry, J. J., Aday, L. A., Zhang, D., & Winn, R. J. (1997). Transportation as a barrier to cancer treatment. Cancer practice5(6), 361–366.

 

Tan, Z. (2016, August 15). Hospitals Are Partnering With Uber to Get Patients to Checkups. Retrieved August 09, 2020, from https://www.theatlantic.com/health/archive/2016/08/hospitals-are-partnering-with-uber-to-get-people-to-checkups/495476/

 

Goins, R. T., Williams, K. A., Carter, M. W., Spencer, S. M., & Solovieva, T. (2005). Perceived barriers to health care access among rural older adults: a qualitative study. The Journal of Rural Health21(3), 206-213. doi: 1111/j.1748-0361.2005.tb00084.x

 

Blazer, D. G., Landerman, L. R., Fillenbaum, G., & Horner, R. (1995). Health services access and use among older adults in North Carolina: urban vs rural residents. American journal of public health, 85(10), 1384–1390. https://doi.org/10.2105/ajph.85.10.1384

 

Branch, L. G., & Nemeth, K. T. (1985). When elders fail to visit physicians. Medical care, 23(11), 1265–1275. https://doi.org/10.1097/00005650-198511000-00005

 

Borders T. F. (2004). Rural community-dwelling elders’ reports of access to care: are there Hispanic versus non-Hispanic white disparities?. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association20(3), 210–220. https://doi.org/10.1111/j.1748-0361.2004.tb00031.x

 

Fitzpatrick, A. L., Powe, N. R., Cooper, L. S., Ives, D. G., & Robbins, J. A. (2004). Barriers to health care access among the elderly and who perceives them. American journal of public health94(10), 1788–1794. https://doi.org/10.2105/ajph.94.10.1788

 

Malmgren, J. A., Martin, M. L., & Nicola, R. M. (1996). Health care access of poverty-level older adults in subsidized public housing. Public health reports (Washington, D.C. : 1974)111(3), 260–263.

 

Rittner, B., & Kirk, A. B. (1995). Health care and public transportation use by poor and frail elderly people. Social work40(3), 365–373.

 

Weber, C. (2018, March 01). Introducing Uber Health, Removing transportation as a Barrier to Care: Uber Newsroom U.S. Retrieved August 09, 2020, from https://www.uber.com/newsroom/uber-health/

 

Georgetown Home Care Announces Partnership with Uber. (n.d.). Retrieved August 09, 2020, from https://www.pr.com/press-release/746068

 

Pro Staff Physical Therapy announces partnership with Uber Health. (2018, May 10). Retrieved August 09, 2020, from http://www.prostaffpt.com/2018/03/01/prostaff-institute-announces-participation-with-uber-health/

 

(n.d.). POH Partners with Uber Health! Retrieved August 09, 2020, from https://www.openhand.org/uber-partnership

 

Herrera, C. (2019, October 29). Uber Health For Patients in Need: BestMedicine News. Retrieved August 09, 2020, from https://bestmedicinenews.org/health/uberhealth/

 

Collective Health and Uber Health Working to Give Select Members Easy Access To Transportation Services. (2018, April 25). Retrieved August 09, 2020, from https://collectivehealth.com/announcements/collective-health-joins-uber-health-program/

 

Lyft, I. (n.d.). Doing more for patients and healthcare organizations amid the COVID-19 crisis. Retrieved August 09, 2020, from https://www.lyft.com/blog/posts/doing-more-for-patients-and-healthcare-organizations

 

Ridesharing May Not Reduce Number of Missed Medical Appointments, Penn Study Finds – P.R. News. (n.d.). Retrieved August 09, 2020, from https://www.pennmedicine.org/news/news-releases/2018/february/ridesharing-may-not-reduce-number-of-missed-medical-appointments-penn-study-finds

 

Abraham, T. (2018, July 23). Lyft, Hitch Health NEMT pilot reduced no-shows by 27%. Retrieved August 09, 2020, from https://www.healthcaredive.com/news/lyft-hitch-health-nemt-pilot-reduced-no-shows-by-27/528401/

 

Health, U. (n.d.). Boston Medical Center + Uber Health: Efficient patient transportation across multiple departments. Retrieved August 09, 2020, from https://businesses.uber.com/rs/613-QPH-162/images/020619_BMC_Case_Study_Interactive_Oct19_R1.pdf

 

Social Determinants of Health Series: Transportation and the Role of Hospitals: AHA. (n.d.). Retrieved August 09, 2020, from https://www.aha.org/ahahret-guides/2017-11-15-social-determinants-health-series-transportation-and-role-hospitals

 

Yu, S., Hill, C., Ricks, M. L., Bennet, J., & Oriol, N. E. (2017). The scope and impact of mobile health clinics in the United States: a literature review. International journal for equity in health16(1), 178. https://doi.org/10.1186/s12939-017-0671-2

 

(n.d.). Case Study: Taylor Regional Hospital’s Van Program Increases Access to Care for Patients: AHA News. Retrieved August 09, 2020, from https://www.aha.org/news/insights-and-analysis/2018-01-18-case-study-taylor-regional-hospitals-van-program-increases

 

Davis, M. A., Anthopolos, R., Tootoo, J., Titler, M., Bynum, J., & Shipman, S. A. (2018). Supply of Healthcare Providers in Relation to County Socioeconomic and Health Status. Journal of general internal medicine33(4), 412–414. https://doi.org/10.1007/s11606-017-4287-4

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