Health Affairs Study Sheds Light on the Value of Transportation Benefits

The research finds that benefits like ride-sharing services might not save money or improve outcomes at first, but they're very important for people who face barriers to accessing care.

A new study in Health Affairs finds that transportation benefits like ridesharing services aren’t improving clinical outcomes and may even be increasing costs, but they’re quite popular with underserved patients who face barriers to accessing healthcare.

The study suggests that such programs may need to be evaluated differently, with an ROI based on reducing barriers to access rather than saving money or even improving health, at least until the program has been up and running for a while.

“Qualitative analyses revealed that participants were highly satisfied with the program, reporting that it eased financial burdens and made them feel safer, more empowered, and better able to take control of their health,” the researchers said. “These findings suggest that although transportation programs are commonly introduced as ways to contain health care spending, it may be better to think of them as programs to improve health care access for people facing difficult circumstances.”

The research team was led by Seth Berkowitz, MD, MPH, of the University of North Carolina at Chapel Hill and includes members from the UNC Health System. They analyzed the experiences of Medicare beneficiaries accessing care through the UNC Health Alliance accountable care organization (ACO) from the beginning of 2017 through the end of 2019.

Their work focuses on the growing trend of addressing social determinants of health, which are factors that exist outside the healthcare realm but which can affect delivery and health outcomes. They include social and economic factors such as homelessness, work status, child (or parent) care, transportation and cultural and community norms.

In some cases the impact on healthcare is clear – someone without a job will likely forego health insurance and only access care in an emergency – while other factors may take time to play out. The challenge for healthcare organizations is to identify the barriers and develop programs that address them.

“Although nonemergency medical transportation is a required Medicaid benefit, increasing recognition of transportation barriers faced by people with other types of insurance coverage, such as Medicare, has led to innovative programs that seek to overcome these barriers,” Berkowitz and his team wrote in their study. “These programs often use smartphone application–based ridesharing programs, which are marketed as offering more affordable and scalable implementation than traditional transportation services.”

“The premise for many of these programs is to increase attendance for outpatient medical appointments,” they continued. “As the conventional wisdom is that many inpatient admissions and emergency departments can be prevented through outpatient medical care, improving outpatient visit attendance could reduce inpatient admissions, emergency department visits, and health care costs.”

According to the research, those who used the transportation program ended up increasing per-person per-year outpatient visits and spent more money on healthcare services than those who had their own transportation. Yet that group didn’t show any notable decrease in hospital admissions or ED visits.

The results do touch upon one criticism of digital health services: that patients who have access to them will use them more often because they’re convenient, and that will lead to unnecessary healthcare visits and higher costs. Digital health proponents, meanwhile, say these services allow more people to access care who would otherwise go without that care, and that excessive use and costs can be filtered out through careful management.

Perhaps more important is the value of these services to the patients who use them. As Berkowitz and his colleagues note, patients who have problems accessing healthcare were grateful to have that barrier removed through a ridesharing program. This reduces stress and saves them money, while also giving them more confidence in managing their health. Those factors could translate into better outcomes and reduced costs down the road.