In some situations, patients without transportation access may wait for a medical emergency just to be able to see a doctor, explained Shreya Kangovi, a professor of medicine at the University of Pennsylvania. “Mr. Jones might have a disability that makes it difficult for him to use public transportation, so he has been waiting until he’s really sick, short of breath, and then calling an ambulance because there is no other good way to get care,” she said.
“If a patient can’t get to see their health-care team, then it’s a domino effect,” said Samina Syed, the lead author of the 2013 study and an endocrinologist in Madison, Wisconsin. “Missed appointments mean that they can’t address their questions and concerns, or update physicians on changes in their health history or life circumstances,” a situation that can be particularly worrisome for patients with diabetes and other chronic diseases that require ongoing active care.
Some health-care providers are trying to lessen the problem by employing community health workers (CHWs), people who help patients navigate the health care system. CHWs, who typically don’t have health-care backgrounds, will coordinate transportation for patients to and from appointments, motivate them to take their medications, and help them implement positive lifestyle habits. In 2014, there were an estimated 50,000 CHWs in the U.S.
A 2003 report on health disparities from the Institute of Medicine praised the CHW model, declaring that it “offer[s] promise … to increase racial and ethnic minorities’ access to health care” and improve their quality of care. Some research has supported this idea: One 2007 study found, for example, that CHWs can help patients better manage their hypertension, and a 2014 study found that patients who worked with CHWs scheduled more primary-care follow-up appointments than those who didn’t.
Some hospitals and physicians also use care coordinators: people who, unlike CHWs, are trained in a health-related field, most often social workers or nurses. These coordinators support groups of low-income or chronically ill patients, helping them to understand their care plans and schedule primary-care visits instead of making trips to the E.R.
Although a significant number of patients, especially those with few resources, struggle to find consistent and reliable transportation, there are some options for those who know how to find them. Each state has a “non-emergency medical transport” benefit for people with Medicaid, covering a certain number of rides per month, and some Medicare Advantage plans also cover a limited number of trips each year (eligibility for this benefit varies by state). Some states contract with local companies to provide rides; others enlist volunteers, or hire taxis. Some private insurers have followed suit, taking similar steps to make transportation more accessible for their clients, though this may involve co-pays or put policyholders through a lengthy bureaucratic process to prove their need for the benefit. In many cases, non-emergency rides must also be requested several days in advance.