Why Car Dependency Makes Healthcare Access Harder — Particularly for the Marginalized

Photo: Rusty Clark, CC
Photo: Rusty Clark, CC

More than 20 percent of car-free U.S. adults in car-dependent places are skipping medical appointments because they can’t physically get to the doctor, compounding the challenge of accessing a broken health system that already too often puts care out of reach even for those with automobiles, a new study finds.

Researchers for the Urban Institute found that “because of difficulties finding transportation,” roughly one in five non-elderly adults without access to a private vehicle or access to good transit were unable to obtain necessary healthcare at some point in the last 12 months. By contrast, only 5 percent of the general population said the same. 

Others, including people with disabilities, low household incomes, and those who rely on public health insurance plans like Medicaid, as well as people of color and those who live in rural areas were likely to skip care because they couldn’t get a ride — even if they did have a car in the household, which those groups disproportionately didn’t.

Graphic: Urban Institute
Click to enlarge. Graphic: Urban Institute

Of course, it’s not exactly news that structurally racist, classist, and ableist planning policies have put critical destinations out of reach of vulnerable families across America, including grocery stores, jobs, schools, and so much more. DOTs generally aren’t required to even measure how easy or difficult it will be for residents to access basic services across all modes as a result of new transportation investments — even though they are generally required to measure how those investments will impact vehicle delays for drivers.

But the researchers emphasize that gaining physical access to healthcare may pose its own unique, compounding challenges for underserved people, many of which have are woefully under-studied.

Urban Institute research associate Laura Barrie Smith pointed out, for instance, that because only 71 percent of hospitals accept Medicaid, recipients are often forced to travel longer distances to see providers they can afford — a problem that may be particularly acute in states that have made fewer people eligible for state-sponsored plans and disincentivized proximal hospitals from accepting public coverage.

A wave of hospital closures in rural areas, meanwhile, are increasingly making it even harder for people in the most transit-poor communities in the country to see a doctor for even routine medical reasons. And that’s not even considering the fact that many disproportionately rural states have enacted or are poised to institute bans on specific forms of care disproportionately needed by low-income people, like abortion, or restrictions on gender-affirming treatment, which people with disabilities already struggle to access — both of which can force patients to either forgo life-saving care or travel hundreds of miles to reach it.

“We have such a complicated healthcare system that there’s never going to be a one-size-fits-all way to promote access to care,” said Barrie Smith. “It’s really going to require people from outside healthcare to work together with policymakers and sustainable transportation advocates to address this.”

The good news is that improved transit can make a huge difference in the lives of car-free Americans — if it’s done right.

Among households without access to a vehicle, only nine percent of the people who reported their public transit access as “excellent, very good, or good” said they’d skipped the doctor for a transportation-related reason in the last year. People who simply lived near a transit line, meanwhile, weren’t always more likely to get care, because proximity alone “may not capture the limitations people face as accurately as their subjective perception of public transportation accessibility,” the researchers wrote. (Put another way: a train station on the corner may not do you any good if the train only comes once an hour, or if you can’t afford the fare, or if you’re terrified of being assaulted by transit police or murdered by another passenger onboard, or any of the other reasons why a marginalized person might not be able to make full use of their shared transportation network.)

Expanding telehealth options and non-emergency medical transportation benefits available under many health insurance plans could help, too, particularly if public transit fares are made eligible in addition to on-demand shuttles.


Active Living For All Ages: Creating Neighborhoods Around Transit

Streetfilms teamed up with the Public Policy Institute at AARP to bring you a look at how Arlington, Virginia plans for its senior population using transit-oriented development (TOD).  Arlington has been practicing TOD since the late 1970s, when Washington’s Metrorail first began service there, and it’s proved very effective in accommodating the population growth of this […]
Source: Smart Growth America

Rural America Badly Needs More Transit

Editor’s note: This article originally appeared on Smart Growth America. It is republished here with permission. Many people think the only Americans regularly relying on transit to reach jobs and services live in big cities. Yet the majority of counties with high rates of zero-car households are rural. In fact, more than one million households in predominantly […]

Sprawl Is a Global Problem

Sprawl isn’t just a problem in car-centric America. Even cities with the world’s best transit systems are surrounded by suburbs with poor transit access, according to a new report by the Institute for Transportation and Development Policy. As billions of people migrate from rural to metropolitan areas in the next few decades, these growth patterns threaten to maroon people without […]

Linking Transportation, Food Access and Health

Is it easier to get to a fast food joint in your neighborhood than a grocery store? In America, the way we answer that question likely says a lot about our income and race. It also has a direct effect on our health. In her latest post on The City Fix, Jonna McKone takes a […]