208073 Understanding transportation barriers to children's health care: Developing a Transportation Disadvantaged Index

Tuesday, November 10, 2009: 1:15 PM

Stephen Borders, PhD , School of Nonprofit and Public Administration, Grand Valley State University, Grand Rapids, MI
Roy Grant, MA , The Children's Health Fund, New York, NY
Dennis Johnson , The Children's Health Fund, New York, NY
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.

Learning Objectives:
1) Discuss the role transportation plays in accessing care. 2) Evaluate differences in access to health care among rural and urban dwelling children receiving Medicaid. 3) Discuss the implications of missed opportunities for preventive care in urban and rural environments. 4) Discuss possible solutions for increasing access to and utilization of medical and dental services in urban and rural environments.

Keywords: Access to Health Care, Children's Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a number of articles and research reports in the area of children's health care, especially transportation barriers to health care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.