Transportation to Clinic: Findings from a Pilot Clinic-Based Survey of Low-Income Suburbanites

Abstract

Health care policymakers have cited transportation barriers as key obstacles to providing health care to low-income suburbanites, particularly because suburbs have become home to a growing number of recent immigrants who are less likely to own cars than their neighbors. In a suburb of New York City, we conducted a pilot survey of low income, largely immigrant clients in four public clinics, to find out how much transportation difficulties limit their access to primary care. Clients were receptive to the opportunity to participate in the survey (response rate = 94%). Nearly one-quarter reported having transportation problems that had caused them to miss or reschedule a clinic appointment in the past. Difficulties included limited and unreliable local bus service, and a tenuous connection to a car. Our pilot work suggests that this population is willing to participate in a survey on this topic. Further, since even among those attending clinic there was significant evidence of past transportation problems, it suggests that a population based survey would yield information about substantial transportation barriers to health care.

Traveling Towards Disease: Transportation Barriers to Health Care Access

“…Nine studies assessed the influence of vehicle access upon access to health care, and all found a positive relationship [24–26, 37–42]. Vehicle access refers to either owning a car or having access to a car through a family member or friend.…”

“…Two studies reported that 25 % of patients missed an appointment due to transportation problems [41, 42]. Yang et al [41] studied 183 urban caregivers from Houston and their children’s missed appointments, finding that an inability to find a ride resulted in at least one missed appointment for 25 % of the sample.…”

“…The study also found that 82 % of those who kept their appointments had access to a car, compared to just 58 % of those who did not keep their appointments. Similarly, in a study of 698 low-income adult patients, Silver et al [42] found that 25 % of missed appointments/rescheduling needs were due to transportation problems and bus users were twice as likely to miss their appointments compared to car users.…”

“…In one study of 200 children with a history of missed appointments, 51 % parents identified transportation barriers as the primary reason for missing clinic appointments [42]. In another study, Yang et al [41] surveyed 183 caregivers of urban children in Texas, and grouped patients based on show rates for a single appointment over a 9-week period.…”

Public Housing Relocations and Relationships of Changes in Neighborhood Disadvantage and Transportation Access to Unmet Need for Medical Care

“…Adequate transportation is fundamental to health care utilization. 14–18 Individuals report poorer health when transportation problems impede their ability to reach care; individuals who report transportation barriers to care are more likely to be female, poor, less educated, and to belong to a racial/ethnic minority than those who were able to travel to care. 16,19 Most studies that have explored the relationship of transportation access to unmet need for medical care use individual-level measures of transportation (e.g., self-reported transportation barriers).…”