Abstract
Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients.
Highlights
Of the 163,277 2-leg round-trips, 16.9% originated in areas classified as rural and 57.2% were for female travelers
Significant differences were observed between non-emergency medical transportation (NEMT) service characteristics for clients in rural versus urban areas expanding upon previous literature documenting rural healthcare differences due to transportation
Transportation to NEMT serves a critical role for millions of Americans, especially those in rural areas where distance to providers may serve as an additional barrier to healthcare access
Summary
It is estimated that over 20% of the American population resides in rural areas and this population is distributed over 80% of the U.S land area [1]. The proportion of the U.S population that is rural. Res. Public Health 2017, 14, 174; doi:10.3390/ijerph14020174 www.mdpi.com/journal/ijerph. Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas
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