A ride to care - a non-emergency medical transportation service in rural British Columbia

Abstract

Access to healthcare services is a chronic problem for rural communities throughout the world. The vast geography of Canada has exacerbated the problem for many northern and remote communities that are hundreds of kilometers away from healthcare centers. As a policy response to this problem, in 2006 the Northern Health Authority of the province of British Columbia (BC) initiated 'Connections', a unique medical transportation service. This service has provided subsidized non-emergency transportation for residents in rural and remote northern communities to reach healthcare centers in neighboring cities. The objectives of this study were to examine the reach of the Connections service in enhancing rural and northern BC communities' access to healthcare services, and to determine the factors that contribute to greater frequency of using this service. The study focused on the demographic, socioeconomic, and health profiles of a random sample of 297 service users. The information on the users' profiles was obtained through a survey questionnaire that was administered by a combination of mail correspondence, computer-assisted phone interviews, and en-route while using the service. Both descriptive and inferential methods are used to analyze the data. The inferential method is the Tobit model for censored ordered dependent variable, which is used to estimate the effects of users' profiles in predicting the frequency of using the service. The descriptive findings of the study suggest that users are typically of older age (>80% aged at least 40 years, 48% at least 60 years), and the majority are women (62%), have low socioeconomic status (61% had income<$30,000, 73% were economically inactive) and self-reported poor health (<52% had poor or fair health, 76% had at least one health problem). Among the various users' attributes, older age, higher level of education, lower employment status, and greater number of health problems were found to be statistically significant (p-values ranged from 0.000 to 0.019) predictors of greater frequency of using the service. The results suggest that the service is being used mainly by those in need; that is, those of older age and poorer health who are economically less advantaged. Such attributes disadvantage this group in terms of healthcare access without the availability of a service like Connections. As an innovative healthcare policy, the Connections service model may be useful in other rural and remote jurisdictions.