Understanding transportation barriers to children's health care: Developing a Transportation Disadvantaged Index

Most discussions of children's healthcare access focus on economic barriers, particularly health insurance. While transportation is frequently cited as a barrier, little conclusive evidence exists about the extent to which transportation is a key factor to healthcare access. A recent survey found that 4% of children (3 million) miss at least one healthcare appointment each year because of transportation, irrespective of insurance status. Among Texas Medicaid recipients, 30% missed at least one healthcare appointment in the last year because of transportation barriers. Using geographic information systems (GIS), we developed a methodology and set of maps to identify communities that are “transportation-disadvantaged”. A variety of data were sought to determine how transportation impacts children's healthcare access by zip code. These include a) ambulatory care sensitive conditions (ACSC) hospitalization rates. Certain conditions like asthma and diabetes are ACSC—that is, hospitalization is largely preventable by timely and appropriate primary healthcare. High rates for these conditions serve as indicators of need for primary care; b) quality of the primary care pediatric safety net, using the presence of federally qualified health centers; c) primary care physician to population ratio; d) availability of the indigenous public transportation infrastructure; and e) superimposing transit routes with the location of community health providers. Although the results are preliminary, we have identified several communities where the combination of health professional shortages and transportation barriers contribute to missed opportunities for children to obtain healthcare and result in increased use of hospital (in-patient and emergency department) resources for non-urgent care.