Transportation Barriers to Health Care Access

R E V I E W

Traveling Towards Disease: Transportation Barriers to Health Care Access

Samina T. Syed • Ben S. Gerber • Lisa K. Sharp

Published online: 31 March 2013

� Springer Science+Business Media New York 2013

Abstract Transportation barriers are often cited as bar-

riers to healthcare access. Transportation barriers lead to

rescheduled or missed appointments, delayed care, and

missed or delayed medication use. These consequences

may lead to poorer management of chronic illness and thus

poorer health outcomes. However, the significance of these

barriers is uncertain based on existing literature due to wide

variability in both study populations and transportation

barrier measures. The authors sought to synthesize the

literature on the prevalence of transportation barriers to

health care access. A systematic literature search of peer-

reviewed studies on transportation barriers to healthcare

access was performed. Inclusion criteria were as follows:

(1) study addressed access barriers for ongoing primary

care or chronic disease care; (2) study included assessment

of transportation barriers; and (3) study was completed in

the United States. In total, 61 studies were reviewed.

Overall, the evidence supports that transportation barriers

are an important barrier to healthcare access, particularly

for those with lower incomes or the under/uninsured.

Additional research needs to (1) clarify which aspects of

transportation limit health care access (2) measure the

impact of transportation barriers on clinically meaningful

outcomes and (3) measure the impact of transportation

barrier interventions and transportation policy changes.

Keywords Healthcare access � Transportation barriers � Medication access � Healthcare barriers

Introduction

Transportation is a basic but necessary step for ongoing

health care and medication access, particularly for those

with chronic diseases (Fig. 1). Chronic disease care requires

clinician visits, medication access, and changes to treat-

ment plans in order to provide evidence-based care.

However, without transportation, delays in clinical inter-

ventions result. Such delays in care may lead to a lack of

appropriate medical treatment, chronic disease exacerba-

tions or unmet health care needs, which can accumulate

and worsen health outcomes [1, 2].

Patients with transportation barriers carry a greater

burden of disease which may, in part, reflect the relation-

ship between poverty and transportation availability [3]. As

a result, understanding the relationship between transpor-

tation barriers and health may be important to addressing

health in the most vulnerable who live in poverty.

Transportation is often cited as a major barrier to health

care access [4–35]. Studies have found transportation barriers

impacting health care access in as little as 3 % or as much as

S. T. Syed (&) Section of Endocrinology, Diabetes and Metabolism, University

of Illinois at Chicago, 1819 W. Polk Street, M/C 640, Chicago,

IL 60612, USA

e-mail: samina.med@gmail.com

B. S. Gerber

Jesse Brown Veterans Affairs Medical Center, Chicago,

IL 60612, USA

e-mail: bgerber@uic.edu

B. S. Gerber

Institute for Health Research and Policy, University of Illinois

at Chicago, MC 275, 454 Westside Research Office Bldg.,

1747 West Roosevelt Road, Chicago, IL 60608, USA

L. K. Sharp

Institute for Health Research and Policy, University of Illinois

at Chicago, MC 275, 463 Westside Research Office Bldg.,

1747 West Roosevelt Road, Chicago, IL 60608, USA

e-mail: sharpl@uic.edu

123

J Community Health (2013) 38:976–993

DOI 10.1007/s10900-013-9681-1

 

 

67 % of the population sampled [25, 36]. The wide variability

in study findings makes it difficult to determine the ultimate

impact that transportation barriers have on health.

This review summarizes and critically evaluates the

empirical evidence on transportation barriers to health care

access for primary and chronic disease care. For each of the

61 studies reviewed, we evaluated the population charac-

teristics, methods, measures of transportation barriers and

results (Table 1). Results are organized into three sections:

(1) measurement of transportation barriers, (2) transporta-

tion barriers and demographic differences, and (3) mea-

surement of the impact of transportation barriers.

Additionally, we define a research agenda based on gaps in

the literature and discuss potential intervention opportuni-

ties and public policy considerations.

Methods

We searched for peer-reviewed studies that addressed

transportation barriers in relation to ongoing health care

access. Inclusion criteria were as follows: (1) study

addressed access barriers for ongoing primary care or

chronic disease care; (2) study included assessment of

transportation barriers; and (3) study was completed in the

United States. Articles dealing with access to prenatal care,

emergency or acute care, or exclusive attention to general

screening and prevention were excluded as they may rep-

resent a single visit or limited time period of care.

We used PubMed with the following keyword search

terms (number of articles returned): transportation barriers

(963), transportation barriers clinic (129), transportation

barriers pharmacy (13), transportation barriers hospital

(183), transportation barriers doctor (69), transportation

barriers health access (276), and transportation barriers

chronic disease (33). Medical Subject Heading (MESH)

terms included health services accessibility AND trans-

portation (575). Additional background information was

found using the terms transportation barriers health access

to search Web of Science and Psych Info, and transpor-

tation barriers to search The New York Academy of

Medicine Library’s Grey Literature Report.

Abstracts were reviewed for inclusion criteria, and if

necessary, full text articles were also reviewed. A sec-

ondary review of bibliographies was also conducted. In the

final review, 61 articles met the inclusion criteria. The

search was concluded in December 2012.

Results

Measures of Transportation Barriers

Vehicle Access and Mode of Travel

Nine studies assessed the influence of vehicle access upon

access to health care, and all found a positive relationship

[24–26, 37–42]. Vehicle access refers to either owning a

car or having access to a car through a family member or

friend. Arcury et al. [37] studied the relationship of trans-

portation to health care utilization in 1,059 rural Appala-

chians and found that people who knew someone who

regularly provided rides to a member of their family had a

greater utilization of health care (Odds Ratio, OR 1.58).

Those with a driver’s license, independent of other factors,

also had greater health care utilization (OR 2.29).

Guidry et al. [26] surveyed 593 cancer patients throughout

Texas, and found 38 % of whites, 55 % of African Americans,

and 60 % of Hispanics identified poor access to a vehicle as a

barrier that could result in missing a cancer treatment.

A study by Salloum et al. [38] looked retrospectively

(2000–2007) at 406 cancer patients to see if patients were

more or less likely to receive first line chemotherapy based

on their demographics. Patients who were significantly less

likely to receive first line chemotherapy lived in neigh-

borhoods that had a higher percentage of households

without any vehicle. Distance to the nearest chemotherapy

facility was not a significant factor.

Rask et al. [40] studied obstacles to care for 3,897 urban,

low socioeconomic status (SES) adults in Atlanta and found

that walking or using public transportation to receive medi-

cal care was an independent predictor of not having a regular

source of care (OR 1.44). Patients who did not use private

transportation were also more likely to delay care (OR 1.45).

Patient

Improved Health Outcomes

Improved care based on clinical guidelines

Appropriate changes to medication regimen

Prevention of chronic disease complications

Timely Medical Care

Clinician Visit

Transportation

Timely Medication Access

New prescriptions/treatments

Medication refills

Fig. 1 Model of relationship between transportation, health care access and outcomes

J Community Health (2013) 38:976–993 977

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