The Transportation Gap Affecting Healthcare
You are living in a city and you need to go to the hospital. If you have a car, great, you can drive door-to-door. But if you don’t have a car, what are your options? Approximately 3.6 million Americans do not obtain medical care due to lack of transportation in a given year (Wallace, 2005). Of this number, children lacking transportation are more concentrated in dense urban areas. This becomes an issue when thinking about holistic health and well-being. Being healthy is not just a matter of eating right and exercising. The World Health Organization defines themes known as the “social determinants of health” as the conditions in which people are born, grow, live, work, and age. Within this framework, the physical environment can contribute to an individual’s health outcomes by either providing assistance or serving as barriers. Specifically, transportation is a key element in the physical environment that can drastically affect health outcomes.
When determining non-financial barriers and access to healthcare, one of the five distinct dimensions includes accessibility (Kullgren, 2012). This is defined as the relationship between the location of the patient and location of the services (transportation resources and travel time). Previously, research has largely emphasized the transportation difficulties presented by extensive distances faced by rural communities when trying to gain access to hospitals or large healthcare centers. Within studies addressing transit accessibility to health care, a review from the Journal of Community Health found travel burden from distance and rural geography to have a negative impact on healthcare access (Syed, 2013).
Texas
Specifically focusing on Texas, a study from the journal Cancer Practice surveyed 593 cancer patients on their transportation to chemotherapy and radiotherapy across the state. It was found that patients opted to forgo needed care in the absence of available and affordable means of transportation to the facilities. The issues were particularly prevalent among minorities, with 60% of Hispanic patients and 55% of Black patients indicating barriers such as distance, access to an automobile, and availability of someone to drive them to the treatment center were potential major problems compared to 38% of white patients (Guidry, 1997).
More recently, the Journal of Health Care for the Poor and Underserved focused on 183 urban caregivers in Houston to investigate the causes for their children’s’ missed appointments . For 25% of participants, inability to find a ride resulted in at least one missed appointment. Additionally, 82% of those who were able to make their appointments had access to a car, compared to 58% of those who would not make their appointments (Yang, 2006). This indicates that even among urban populations, where public transportation systems are often found, transportation still affects access to health care. As illustrated by Gillian White in The Atlantic, for those who do not have a car, public transport is vital but often underdeveloped in poorer neighborhoods. Especially for those who are disabled or chronically ill, riding public transportation can present itself with logistical challenges.
Austin
Clearly there is an established case for accessible and affordable transportation for health care. But just how good is Austin at preventing this transportation barrier? Austin’s medical centers are known for their high-quality healthcare, reflected in their rankings and reputations. Dell Children’s Medical Center is nationally accredited and has ranked in the top 50 on U.S. News and World Report’s annual list of best hospitals, with Seton Medical Center recognized as the best hospital in the Austin area. However, having high quality healthcare doesn’t matter if people have no way of getting to it.
According to Walk Score, a website that assigns a “usefulness” value based on frequency, type of transit, and distance between stops with a city’s public transport agency’s data, Austin’s public transit score is 34/100. This places it in the second lowest category, defined as “some transit: a few nearby public transportation options.” Public transportation in Austin is largely dominated by bus service run by Capital Metro. The agency runs 82 bus routes throughout Austin and it’s surrounding areas, with a fleet of 404 busses and 171 paratransit vehicles.
This does not necessarily equate to assured access to medical centers if an individual does not have a car. When examining the bus routes throughout central Austin, there does appear to be enough routes covering the city that technically would provide access to a major medical center. However, this does not take into effect the practical or logistical parameters surrounding using the bus to get to the hospital.
The Holly Example
For example, from the Holly neighborhood in East Austin to the Dell Children’s Medical Center just 4 miles away is an approximately 13 minute car journey door to door. Using the most efficient bus route provided by CapMetro estimates is a 38 minute journey with just over half a mile of walking on either end to get to the stop/to the hospital, but involves 2 bus routes, resulting in an increased fare for the transfer. The next best suggested route requires only 1 bus, but requires a mile and a half of walking for a total journey time of 41 minutes. The last option again requires 1 bus, but has a total journey time of 54 minutes, of which there is just under 2 miles of walking.
Practicality
None of these options are ideal, but to test the practical usage of the bus routes I went to the Holly neighborhood and took the best suggested route as per GoogleMaps and CapMetro’s suggestions. From the 7th street stop, I arrived 5 minutes before the bus was scheduled to pick up at 10:28 am. The #4 bus did arrive on time, and I rode it to 7th and Chicon, where I departed and transferred to the Huston-Tillotson stop. The next bus, the 320, was due to arrive 2 minutes later at 10:35 am, but as I followed the real-time bus updates on the CapMetro app, I saw that it continually claimed to be due in 1 minute, even as time passed. Eventually the 320 arrived at 10:41 am, and I rode it to the Barbara Jordan stop. I then walked 10 minutes through parking lots, the suggested walking route, before arriving at Dell Children’s at 11:11 am. My total journey time was 43 minutes, just 5 minutes over the estimate. I was able to walk the half mile and navigate the buses, but for some caregivers and their children it may not be this simple.
Is this realistic?
In this particular zipcode and area of the Holly neighborhood, 76.5% of family households include children, indicating it is highly likely that Dell Children’s may be a trafficked location by these families. Additionally, 73.3% of the houses in this area are renter occupied, where the median vehicle ownership is 0 per household. In reference to the earlier Houston study where car ownership led to a higher likelihood participants would make their children’s appointments, this population of non-car owning households is at an increased risk of not making it to their children’s hospital. Therefore there should be usable public transport that doesn’t require long wait times or a mile of walking.
Bibliography
Kullgren, J. T., McLaughlin, C. G., Mitra, N., & Armstrong, K. (2012). Nonfinancial barriers and access to care for US adults. Health services research, 47(1pt2), 462–485.
Wallace, R., Hughes-Cromwick, P., Mull, H., & Khasnabis, S. (2005). Access to health care and nonemergency medical transportation: two missing links. Transportation Research Record: journal of the transportation research board, (1924), 76–84.
Yang, S., Zarr, R. L., Kass-Hout, T. A., Kourosh, A., & Kelly, N. R. (2006). Transportation barriers to accessing health care for urban children. Journal of Health Care for the Poor and Underserved, 17(4), 928–943.
Syed, S. T., Gerber, B. S., & Sharp, L. K. (2013). Traveling towards disease: transportation barriers to health care access. Journal of community health, 38(5), 976–993.
Guidry, J. J., Aday, L. A., Zhang, D., & Winn, R. J. (1997). Transportation as a barrier to cancer treatment. Cancer practice, 5(6), 361–366.
White, G. (2015, May 16). Stranded: How America’s Failing Public Transportation Increases Inequality. Retrieved from https://www.theatlantic.com/business/archive/2015/05/stranded-how-americas-failing-public-transportation-increases-inequality/393419/
Social determinants of health. (2018). Retrieved from http://www.who.int/social_determinants/themes/urbanization/en/
Cronk, I. (2015, Aug 9). The Transportation Barrier. Retrieved from https://www.theatlantic.com/health/archive/2015/08/the-transportation-barrier/399728/
Best Hospitals in Texas. (2018). Retrieved from https://health.usnews.com/best-hospitals/area/tx
Walk Score: Living in Austin. (2018). Retrieved from https://www.walkscore.com/TX/Austin
Capital Metro Fast Facts. (2018). Retrieved from https://www.capmetro.org/facts/#
