Transportation as a barrier child health access: The scope of the problem

Most discussions of barriers to accessing health care for medically underserved children focus on health insurance. Non-economic barriers, e.g., workforce distribution and transportation, are less often addressed. Historically and currently, there are too few healthcare providers in rural communities. In these “health professional shortage areas” (HPSAs), it is necessary to travel long distances to see a doctor. To quantify the extent of the problem of transportation as a barrier to child health access, we developed, with the Marist Institute for Public Opinion, a survey instrument and administered it to a nationally representative sample (N=1,819) in September 2006. Results: Public transportation is least available in rural communities, with 75% reporting no transport resources vs. 9% in big cities and 27% in suburbs. Only 23% with transport access used it regularly. Reasons for non-use included problems with route, schedule, and reliability. Nationally, 35% of parents must travel ten or more miles to get pediatric care, 7% routinely used the emergency room for acute care; and 4% missed at least one health appointment because of transportation. Of those missing a health appointment because of transportation, most missed two or more per year. One third later required emergency room care for the condition involved. Applied to 2002 Census data, nationally nearly 3 million children miss at least one healthcare appointment each year because of transportation restrictions, associated with up to 1 million preventable ER visits. Using MEPS cost data, the savings in ER visits alone attributable to enhanced transport access could be $75 million/year.