A couple of years ago I met with a kidney specialist in Atlanta. He told me that when one of his patients needs dialysis, the first question he asks has nothing to do with the person’s medical history or insurance coverage. Rather, it is, “Where do you live?”
Dialysis is a difficult treatment regimen. It requires several hours hooked up to a machine in a dialysis center three times a week, drains your energy, and must be done for a lifetime unless you’re lucky enough to get a kidney transplant. In addition to the physical challenges, dialysis makes it harder to work, travel, and live a normal life.
But this doctor knows from experience that one of the most important factors in his patients’ long-term health outcomes is how close they live to a treatment center and how reliable their transportation is. What seems like the simplest part of the treatment—a ride to and from the appointment—becomes the trigger for major health problems when a vehicle is late or never shows up.
The Most In Need Are The Hardest Hit
Every year, 3.6 million Americans miss at least one medical appointment because they don’t have a way to get there. They tend to be the most vulnerable people–mostly low-income, many living in rural areas. Demographic changes in the upcoming decades mean we’ll have more older adults and people with disabilities. These people are less likely to drive, adding more stress to transit, subsidized programs, as well as family and friends who sometimes pitch in.
The transportation system we have now is fractured, was built to prioritize cars over people, and is financially unsustainable. We have the opportunity to design a better system and to include the needs of transportation disadvantaged people in the solutions so that they don’t continue to be left behind.
Steps To Strengthen The Partnership
The healthcare industry can and should be our partners in this work, and are already working in parallel in several key ways.
First, both transportation and healthcare rely on public subsidies to function—more than a third of all Americans are covered by Medicare, Medicaid, or another public program. We all have an interest in being responsible stewards of public investments.
Second, healthcare providers have access to individual data and the ability to show how transportation access or barriers affect us at the most fundamental level–our health.
Lastly, the healthcare industry has a financial incentive to be part of the transportation solution, because the negative effects of transportation barriers can have huge costs in medical care as well as quality of life.
What’s Being Done Now
There are a few programs out there. Some providers bring the service to the patient, whether it’s a phone or video consultation, prescription delivery, or even a house call. FTA is on its third round of funding for healthcare access pilot programs to identify best practices, and they require the applicant team to include a transportation and healthcare provider as well as a customer.
Innovation is also coming to the Medicaid and Medicare non-emergency medical transportation programs. Lyft has partnered with Logisticare, the industry’s largest network of contracted transportation services, to improve service delivery. However, technology is only one part of the solution. Uniform metrics and data collection and storage standards are needed across states and across the range of federally-funded programs. That’s the only way we’ll be able to understand and compare programs and measure success.
Continuing and expanding our partnerships with healthcare, and including the needs of the most vulnerable Americans in our solutions, is what we need to do so that we can get to a place where the most important question we ask about health isn’t how hard it is to access it.
This post was written by Renee Autumn Ray, who works at the intersection of transportation and health. She has consulted on projects for the Federal Transit Administration, Federal Highway Administration, Centers for Disease Control and Prevention, and United Healthcare.