One in 5 adults without cars, transit access defer care, survey finds

More than 1 in 5 non-senior adults without access to a car or public transit missed or skipped a medical appointment in the past year, according to a new study.

Five percent of all U.S. adults reported forgoing healthcare due to transportation barriers, the study found, based on newly published survey data from the Urban Institute and the Robert Wood Johnson Foundation. The study is based on June 2022 responses to Urban's annual, roughly 9,000-person Health Reform Monitoring Survey.

Adults who reported they did not own a vehicle but said they had good to excellent neighborhood access to public transit were significantly less likely to skip needed care (9%), the study found.

Specifically, Urban found that more adults who were Black (8%) and Hispanic/Latinx (7%) reported missing care due to transportation than white (4%) and Asian (2%) respondents.

Similar trends were also apparent among those who had low family incomes (14%), had public health insurance as opposed to private coverage (12% vs. 2%) and adults with a disability (17%), according to the survey data.

“These findings add to the growing body of evidence that inequitable access to transportation perpetuates disparities in access to health care, highlighting the importance of transportation as a social determinant of health,” Urban researchers wrote in a report on the data.

“While substantial increases in the availability of telehealth since the start of the COVID-19 pandemic likely reduced transportation barriers for some types of healthcare, especially mental health and primary care services, telehealth is not accessible to all adults and cannot substitute for in-person care for all healthcare needs,” Urban researchers wrote in the study.

For healthcare policymakers, the group said the findings are a potential case for extending pandemic telehealth coverage to those with transportation barriers as well as for expanding transportation benefits within health plans.

The latter idea has led big-name ride-share companies like Uber and Lyft to expand their businesses into nonemergency medical transport (NEMT). Payers have also targeted NEMT platforms like SafeRide Health for strategic investment to bring these services to members, particularly those who are older, in a bid to improve outcomes and limit the billions lost to missed appointments each year.

More broadly, however, researchers said the data reaffirm prior findings that associated public transit systems with better health outcomes and suggest “that investments in public transit may be a tool to promote health equity.”