A little background and an admission that I am not a researcher. Medicaid, which, unlike Medicare, operates differently in every state, is required to provide transportation for its clients, but no other healthcare insurers, including Medicare, are obligated to do so. That means that many older adults and those who became ill in mid-life who are unable to or who cannot afford to drive are dependent on under-funded non-profit transportation providers and volunteer transportation programs. Medicaid's "guarantee" of transportation does not mean convenient transportation or transportation coordinated with medical care. Indeed, in some states one might strongly suspect that the low quality of transportation provided constitutes a strong inducement to find alternative transportation, thereby magically reducing the financial burden on the state. However, the increase in the numbers of dialysis patients, who need transportation a few times a week, and behavioural health patients are straining the system in many states, causing further erosion in the quality of non-emergency Medicaid transportation from a patient perspective. There is, of course, much more to be said, but the combination of communities designed against maintenance of health and the poor access to transportation for healthcare makes health a more difficult status to achieve or maintain for individuals and families who are poor. Excuse me if I have rattled on about something you are already familiar with. Hank Weiss &lt;hank.weiss(a)otago.ac.nz&gt; wrote: >Kara: > >Thank you and Chris for sharing; this is great you are doing this work. Several other aspects are worth mentioning. > >The first is something I am sure some of the references discuss. Like the way we have built much of our infrastructure, little attention is paid to anything other than private motor vehicle access when planning health facilities. This sometimes leads to a false dichotomy by "blaming" lack of MV ownership/access as an important part of the problem. As people on this list serve know, it's more complex than that. Encouraging more/cheaper car use among people who cannot afford it is not the solution, especially when car dependency may be part of the reason why such people are in need of medical care in the first place! The many feedback loops and their directions are not yet well elucidated. A telling exercise is to go the public website of any hospital or clinic and look for walking, biking and transit directions. > >I would also suggest that such work not focus only on the sick patient and transport for care. It is often someone else who makes the transport decision. Further, the trips generated by inpatient illness episodes are mostly by employees, suppliers, family and friends, not the patient. One wonders if and how disparity in outcomes might be related to how difficult it is for family and friend supporters to be part of the disease care and recovery experience and the role accessibility plays. > >The injury dimension of transport mode and health outcomes also should not be neglected. There is a small separate literature that looks at the safety of EMS and ambulances from a patient perspective. National data are hard to come by, however. But ambulances and ambulance runs can be risky endeavors. Look for the work by Dr Nadine Levick. This pertains to non-ambulance trips as well. How many pregnant women and babies are injured during the urgent private drive to the hospital? I doubt such episodes are tracked and I doubt the risks of transport are ever calculated in cost benefit analyses of medical care planning or providing in almost any setting. > >Lastly, I can't put my finger on it at the moment, but there was a flurry of important work in this area during the 70's oil embargo for obvious reasons. As private car use and access declines on a per capita basis, a well-documented nine year trend*, the issues of transport and healthcare access will become more and more important. > >Hank Weiss > >--------------------- >*"Evidence suggests that the decline is likely due to changing demographics, saturated highways, and a rising preference for compact, mixed-use neighborhoods, which reduce the need for driving" . http://www.ssti.us/2014/02/vmt-drops-ninth-year-dots-taking-notice/ > > > >-----Original Message----- >From: h+t--friends-bounces(a)chrispy.net [mailto:h+t--friends-bounces@chrispy.net] On Behalf Of h+t--friends-request(a)chrispy.net >Sent: Monday, March 03, 2014 7:00 AM >---------------------------------------------------------------------- > >Message: 1 >Date: Sat, 1 Mar 2014 10:41:00 -0800 >From: "Kara E. MacLeod" &lt;kara.e.m(a)gmail.com&gt; >Subject: Re: [H+T--Friends] H+T--Friends Digest, Vol 35, Issue 1 >To: h+t--friends(a)chrispy.net >Message-ID: > &lt;CAGT3rCB0kN8MT5hSkMRX20CMLVbtXn8aOTAanmdjo3cqRZAE=A(a)mail.gmail.com&gt; >Content-Type: text/plain; charset="iso-8859-1" > >At UC Berkeley SafeTREC we are working on a Medicaid transportation study. > Here is some background from one of our recent publications with references at the end. > > Transportation barriers have been associated with poorer health care access, differential treatment, missed or delayed medical appointments, and lower health status (Fitzpatrick, Powe, Cooper, Ives, & Robbins, 2004; Goodwin, Hunt, & Samet, 1993; Gwira et al., 2006; Horton & Johnson, 2010; Okoro, Strine, Young, Balluz, & Mokdad, 2005; Rittner & Kirk, 1995). >Transportation has been recognized as a key ele- ment of health care access, which highlights its role to offset long-term health consequences. >Delayed medical care may adversely affect patients' quality of life and result in more depressive symptoms (Owsley et al., 2007). These delays can also lead to an increased need for emergency care and pre- ventable hospitalizations and result in higher medical costs (Hughes-Cromwich & Wallace, 2006; Rust et al., 2008). > >Approximately 3.6 million adults miss or delay non- emergency medical care due to transportation barriers (Hughes-Cromwich & Wallace, 2006). The population missing these visits may be particularly susceptible to poorer health status and higher cost of care. These transpor- tation barriers are more likely to influence older individu- als, females, minorities, and those with lower income levels (Hughes-Cromwich & Wallace, 2006; U.S. >Government Accountability Office, 2003). Medicaid acknowledges the importance of transportation for vulnerable populations and the associated potential costs of delayed medical care (Kim, Norton, & Stearns, 2009). In fact, federal Medicaid requires that states "ensure necessary transportation for recipients to and from providers" to help meet the needs of this population and the intent of Medicaid (The Hilltop Institute, 2008 ). > >Bellamy,G. R., Stone,K., Richardson,S. K., & Goldsteen,R. L. (2003). >Getting from here to there: Evaluating West Virginia's rural nonemergency medical transportation program. Journal of Rural Health, 19(Suppl), 397-406. > >Community Transportation Association of America. (2008). Federal Register, 73, 245. http://web1.ctaa.org/webmodules/webarticles/ >articlefiles/cms1219.pdf<http://web1.ctaa.org/webmodules/webarticles/articlefiles/cms1219.pdf> >. > >Community Transportation Association of America. (2009). America's Affordable Health Choices Act of 2009. http:// www.ctaa.org/webmodules/webarticles/articlefiles/AAHCA_ >BillText_071409.pdf<http://www.ctaa.org/webmodules/webarticles/articlefiles/AAHCA_BillText_071409.pdf>. > > >Community Transportation Association of America. (2010). An overview: How health care reform impacts community and public transportation. >http://web1.ctaa.org/webmodules/webar- >ticles/anmviewer.asp?a=1672&z=5<http://web1.ctaa.org/webmodules/webar-ticles/anmviewer.asp?a=1672&z=5>. > > >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 Health, 94, 1788-1794. >http://dx.doi.org/10.2105/AJPH.94.10.1788. > >Goodwin,J. S., Hunt,W. C., & Samet,J. M. (1993). Determinants of cancer therapy in elderly patients. Cancer, 72, 594-601. > >Gwira,J. A., Vistamehr,S., Shelsta,H., Bashford,K., Forster,S., Palmisano,P., Shafranov,G., & Shields,M. B. (2006). Factors associated with failure to follow up after glaucoma screening: a study in an African American population. Ophthalmology, 113, 1315-1319. >http://dx.doi.org/10.1016/j.ophtha.2006.04.017 > >Horton,S., & Johnson,R. J. (2010). Improving access to health care for uninsured elderly patients. Public Health Nursing, 27, 362- 370. >doi:10.1111/j.1525-1446.2010.00866.x > >Hughes-Cromwich,P. & Wallace,R. (2006). Cost benefit analy- sis of providing non-emergency medical transportation. Transportation Research >Record: Journal of the Transportation Research Board, 1956, 86-93. >doi:10.3141/1956-11 > >Kim,J., Norton,E. C., & Stearns,S. C. (2009). Transportation brokerage services and Medicaid beneficiaries' access to care. Health Services Research, 44, 145-161. doi:10.1111/j.1475-6773.2008.00907.x > > Leduc,N., Tannenbaum,T. N., Bergman,H., Champagne,F., Clarfield,A. M., & Kogan,S. (1998). Compliance of frail elderly with health services prescribed at discharge from an acute-care geriatric ward. Medical Care, 36, 904-914. doi:10.1097/00005650-199806000-00013 > >Leutz,W., & Capitman,J. (2007). Met needs and unmet needs, and satisfaction among Social HMO members. Journal of Aging & Social Policy, 19, 1-19. >doi:10.1300/J031v19n01_01 > >Lynott,J., Fox-Grage,W., & Guzman,S. (2013). Weaving it together: A tapestry of transportation funding for older adults. AARP Public Policy Institute. http://www.aarp.org/research/ppi/liv- >com2/policy/transportation/articles/weaving-it-together-trans- >portation-funding-for-older-adults-AARP-ppi-liv-com.html<http://www.aarp.org/research/ppi/liv-com2/policy/transportation/articles/weaving-it-together-trans-portation-funding-for-older-adults-AARP-ppi-liv-com.html> > >Nasvadi,G. E. & Wister,A. V. (2006). Informal social support and use of a specialized transportation system by chronically ill older adults. Environment and Behavior, 38, 209-225. doi:10.1177/0013916505277605 > >Owsley,C., McGwin,G. Jr, Scilley,K., Meek,G. C., Seker,D., & Dyer,A. >(2007). Effect of refractive error correction on health-related quality of life and depression in older nursing home residents. Archives of Ophthalmology, 125, 1471-1477. doi:10.1001/ archopht.125.11.1471 > >Rittner,B., & Kirk,A. B. (1995). Health care and public transpor- tation use by poor and frail elderly people. Social Work, 40, 365-373. >http://search.proquest.com/docview/1297015299?acc >ountid=14496 <http://search.proquest.com/docview/1297015299?accountid=14496> > >Rust,G., Ye,J., Baltrus,P., Daniels,E., Adesunloye,B., & Fryer,G. E. >(2008). Practical barriers to timely primary care access: Impact on adult use of emergency department services. Archives of Internal Medicine, 168, 1705-1710. doi:10.1001/ archinte.168.15.1705 > >The Hilltop Institute. (2008). Non-Emergency Medical Transportation (NEMT) Study Report. http://www.hilltopinsti- tute.org/publications/Non-EmergencyMedicalTransportationSt >udyReport-September2008.pdf<http://tute.org/publications/Non-EmergencyMedicalTransportationStudyReport-September2008.pdf>. > > >Whittier,S., Scharlach,A. E., & Dal Santo,T. S. (2005). Availability of caregiver support services: Implications for implementation of the National Family Caregiver Support Program. Journal of Aging and Social Policy, 17, 45-62. doi:10.1300/J031v17n01_03 > >Yeatts,D. E., Crow,T., & Folts,E. (1992). Service use among low- income minority elderly: Strategies for overcoming barriers. The Gerontologist, 32, 24-32. doi:10.1093/geront/32.1.24 > > > > >On Sat, Mar 1, 2014 at 10:00 AM, &lt;h+t--friends-request(a)chrispy.net&gt; wrote: > >> >> Today's Topics: >> >> 1. Access to Health Care (Ed Christopher) >> 2. Re: Access to Health Care (Rajiv Bhatia) >> 3. Re: Access to Health Care (denita Jones) >> 4. Re: Access to Health Care (Rajiv Bhatia) >> >> >> ---------------------------------------------------------------------- >> >> Message: 1 >> Date: Fri, 28 Feb 2014 14:43:16 -0600 >> From: Ed Christopher &lt;edc(a)berwyned.com&gt; >> Subject: [H+T--Friends] Access to Health Care >> To: TRB Health and Transportation &lt;h+t--friends(a)chrispy.net&gt; >> Message-ID: &lt;5310F4E4.9060008(a)berwyned.com&gt; >> Content-Type: text/plain; charset=ISO-8859-1; format=flowed >> >> I got asked a question today, from a transportation perspective, about >> access to health care and health facilities. As I started to hunt >> around on the web I thought I would throw it out to our Listserve. >> Does anyone know of any research, literature or other articles that >> they could pass along dealing with access to health care services? >> >> Thanks >> -- >> Ed Christopher >> >> >> ------------------------------ >> >> Message: 2 >> Date: Fri, 28 Feb 2014 13:13:39 -0800 >> From: Rajiv Bhatia &lt;rb6419(a)gmail.com&gt; >> Subject: Re: [H+T--Friends] Access to Health Care >> To: TRB Health and Transportation &lt;h+t--friends(a)chrispy.net&gt; >> Message-ID: &lt;73BF7334-5E7C-4BC7-8B00-1C6139B8B486(a)gmail.com&gt; >> Content-Type: text/plain; charset=us-ascii >> >> There is limited information on this topic. I did a review of this >> and other EJ impacts for EPA a few years ago. >> >> A few studies have looked at transport access to facilities and their >> association to health outcomes. Most studies treated the "exposure >> variable" as auto ownership. Net conclusion is that auto owners have >> better access to health facilities. THere is a very limited association >> to health outcomes. >> >> I would not take this as a null result -- just one that has been >> understudied. >> >> Rajiv >> >> >> >> On Feb 28, 2014, at 12:43 PM, Ed Christopher &lt;edc(a)berwyned.com&gt; wrote: >> >> > I got asked a question today, from a transportation perspective, >> > about access to health care and health facilities. As I started to >> > hunt around on the web I thought I would throw it out to our >> > Listserve. Does anyone know of any research, literature or other >> > articles that they could pass along dealing with access to health care services? >> > >> > Thanks >> > -- >> > Ed Christopher >> > _______________________________________________ >> > H+T--Friends mailing list >> > H+T--Friends(a)chrispy.net >> > https://www.chrispy.net/mailman/listinfo/h+t--friends >> >> >> >> >> ------------------------------ >> >> Message: 3 >> Date: Fri, 28 Feb 2014 15:12:18 -0600 >> From: denita Jones &lt;denita944(a)gmail.com&gt; >> Subject: Re: [H+T--Friends] Access to Health Care >> To: TRB Health and Transportation &lt;h+t--friends(a)chrispy.net&gt; >> Message-ID: >> <CAKZGZAxDq9_5x+JQrc_Z3oL5oFe5yYaE4zKh= >> 5vJ7_jHgdNnmA(a)mail.gmail.com&gt; >> Content-Type: text/plain; charset="iso-8859-1" >> >> Im actually presenting research in that area in DC next month. I'm not >> in a position now to give the names of articles (im driving) But I can >> send them to you and suggest sites. >> On Feb 28, 2014 3:07 PM, "Ed Christopher" &lt;edc(a)berwyned.com&gt; wrote: >> >> > I got asked a question today, from a transportation perspective, >> > about access to health care and health facilities. As I started to >> > hunt around on the web I thought I would throw it out to our >> > Listserve. Does anyone know of any research, literature or other >> > articles that they could pass along dealing with access to health care services? >> > >> > Thanks >> > -- >> > Ed Christopher >> > _______________________________________________ >> > H+T--Friends mailing list >> > H+T--Friends(a)chrispy.net >> > https://www.chrispy.net/mailman/listinfo/h+t--friends >> > >> -------------- next part -------------- An HTML attachment was >> scrubbed... >> URL: >> https://www.chrispy.net/pipermail/h+t--friends/attachments/20140228/26 >> 257ec5/attachment-0001.html >> >> ------------------------------ >> >> Message: 4 >> Date: Fri, 28 Feb 2014 18:58:16 -0800 >> From: Rajiv Bhatia &lt;rb6419(a)gmail.com&gt; >> Subject: Re: [H+T--Friends] Access to Health Care >> To: TRB Health and Transportation &lt;h+t--friends(a)chrispy.net&gt; >> Message-ID: &lt;B6368ACB-B234-45D2-87FB-80F7D05E9F54(a)gmail.com&gt; >> Content-Type: text/plain; charset="us-ascii" >> >> Ed >> >> These are the studies I found in a 2009 review -- i'm sure there are >> new ones. >> >> 1. Ahmed SM, Lemkau JP, Nealeigh N, and Mann B. Barriers >> to healthcare access in a non-elderly urban poor American population. >> Health and Social Care in the Community. 2001; 9:445-453. >> >> 2. Yang S, Zarr RL, Kass-Hout TA, Kourosh A, Kelly NR. >> Transportation barriers to accessing health care for urban children. >> Journal of Health Care for the Poor and Underserved. 2006; 17:928-43. >> >> 3. Rust G, Ye J, Baltrus P, Daniels E, Adesunloye B, Fryer >> GE. Practical barriers to timely primary care access: impact on adult >> use of emergency department services. Archives in Internal Medicine. >> 2008; 168:1705-1710. >> >> 4. Arcury TA, Preisser JS, Gesler WM, Powers JM. Access to >> transportation and health care utilization in a rural region. Journal >> of Rural Health. 2005; 21:31-38. >> >> >> >> On Feb 28, 2014, at 12:43 PM, Ed Christopher &lt;edc(a)berwyned.com&gt; wrote: >> >> > I got asked a question today, from a transportation perspective, >> > about access to health care and health facilities. As I started to >> > hunt around on the web I thought I would throw it out to our >> > Listserve. Does anyone know of any research, literature or other >> > articles that they could pass along dealing with access to health care services? >> > >> > Thanks >> > -- >> > Ed Christopher >> > _______________________________________________ >> > H+T--Friends mailing list >> > H+T--Friends(a)chrispy.net >> > https://www.chrispy.net/mailman/listinfo/h+t--friends >> >> -------------- next part -------------- An HTML attachment was >> scrubbed... >> URL: >> https://www.chrispy.net/pipermail/h+t--friends/attachments/20140228/d5 >> 9c5e33/attachment-0001.html >> >> ------------------------------ >> >> _______________________________________________ >> H+T--Friends mailing list >> H+T--Friends(a)chrispy.net >> https://www.chrispy.net/mailman/listinfo/h+t--friends >> >> >> End of H+T--Friends Digest, Vol 35, Issue 1 >> ******************************************* >> >