Today, there is sufficient evidence of inequity in healthcare for different demographics in America. And although the popular opinion that all Americans should have equal access to healthcare exists, the actual case is that many Americans are denied access to quality healthcare considering factors like structural racism, socioeconomic status, age, occupation, etc. Various systems have been designed to create equal access to healthcare for all Americans, but safe to say that these structures have effectively transformed the reality of healthcare inequity.
In 2017, the American Health Association report noted that 3.6 million individuals – regardless of payer status, lacked healthcare access because of logistics issues that kept them from medical appointments. In addition, a record 4% of children still miss medical appointments for the same reason. In addition, the report traced patient absence at medical appointments to transportation problems as the third leading cause. Also, these statistics prove to be instances of challenges with access to and knowledge of non-emergency medical transportation, not including emergency medical condition statistics.
Unfortunately, issues in non-emergency medical transportation negatively affect both patient health and the healthcare revenue cycle. When a patient misses an appointment, the situation is such that it would likely negatively impact their health and wellness, potentially creating a set of chain reactions that are a sign of increasing healthcare expenses. The situation is especially prevalent in patients who manage chronic conditions and visit their providers for regular check-ins. When this demographic of patients miss their appointments, the healthcare practitioner is hindered from tracking the developments of their condition, leading to a deterioration in health, often resulting in significant expenditure to bring about patient health stabilization and recovery—the overall negative outcomes build-up for the individual which can, in turn, negatively change the efficacy of their health plan.
In light of the problems identified and articulated thus far, it is evident that there is both an essential and urgent need for interventions in medical transportation services, especially in the sub-issue of non-emergency medical transportation (NEMT). Institutions, healthcare providers, and other stakeholders in healthcare, including the government, should consider the right questions for innovating NEMT solutions so that the actors concerned can overcome this barrier to health care access.
Furthermore, social determinants of health should be examined as a strategy of understanding the nature of healthcare access. When this is achieved, we will understand the hindrances that social status inequalities and structural racism can cause in healthcare access, particularly in medical transportation management.
Social Determinants of Health and Non-emergency Medical Transportation Inequities
There are many social determinants of health: access to housing, poverty, education, and structural racism.
First off, some individuals who miss medical appointments reside in remote rural locations because they cannot afford housing in urban areas near healthcare facilities. This inability to live elsewhere is a well-defined social determinant of health. Certain areas are so remote that almost any medical transport refuses to come to them.
Second, it is not the distance that creates a lack of health equity. Instead, citizens who miss medical appointments lack access to working automobiles or cannot afford transportation costs to visit the healthcare facility due to poverty or unemployment. Also, a large percentage of people with low incomes cannot afford internet or mobile phone data plans.
Thirdly, some don’t have the educational background to access or use the information found using the internet, a library, a landline, or reaching out to family or friends. Even when transport subsidies or other measures that relieve their burdens are shared, they cannot access or effectively use them if not given the proper consideration and accommodation.
Finally, one longstanding factor that creates inequality in NEMT is structural racism. A doctor at the Rush University Medical Centre in Chicago, David Ansell, describes how historical and ongoing economic deprivation of racially-specific neighborhoods contributes to some of the most significant sources of healthcare inequity. Certain areas populated by racialized groups are often outside city centers, are afforded less infrastructure, or have fewer public transportation routes. David Ansell further described structural violence as the basis of low life expectancy in marginalized communities because it is “designed into” laws and policies. His position was that until academic medical centers and other health facilities confront these issues as the initial step in identifying ways to address health inequities, inequity in NEMT in particular, and healthcare access in general, will continue.
With this work having examined all of the causes of the barriers facing NEMT, it is essential to consider the solutions that Health Offices and Medicare providers implement to eliminate problems.
How NEMT Solutions Start Local and Go Global
Statistics estimate that 16% of Medicare recipients see a doctor for annual wellness, while 27% of US citizens did not visit a doctor in 2020. COVID may have contributed to this percentage, but it’s still enough to consider when trying to find ways forward in finding medical treatment equity. The importance of consistent doctor visits cannot be overstated in the sense that those who receive an annual wellness visit receive 62% more preventive screening for chronic diseases than those who do not. In the light of this, one may say that this practice significantly affects the health management of many individuals.
1. Improving Communication
Improved communication is one of the NEMT solutions that medical offices advocate for to achieve better healthcare access and patient outcomes. Unfortunately, many stakeholders often miss the connection between proper communication and non-emergency medical transportation. They observe that many people miss health appointments, not because they cannot access transportation services, but because they either do not know that the health and transportation benefits exist or have not received clear notice on how significant these benefits are. Thus, medical plans are taking the lead on communicating this significance to members —in their preferred channels, as previously mentioned, but also in the informative language that conveys the benefits of such visits as well as the risks associated with skipping them. As better methods become apparent, each stage of increased comprehensive communication grows upwards into larger systems, moving nationally and even internationally.
2. Software to Develop Transportation Efficiency
Another way hospitals and other healthcare institutions are improving medical transportation and challenging the NEMT barrier is by organizing efficient logistics with medical dispatch software. For example, health plan operators can swiftly create a database for their clients who need transportation services to attend their appointments with medical dispatch software. Consequently, they can organize any order or category of priorities, such as for aged individuals who cannot use transportation services without help and people who cannot move around without assistance due to certain differences in ability. Mobility is a significant factor in connecting individuals and communities to large social systems and institutions. Health and medicine connect people across borders. The better connected the individual is, the healthier the system, the more the community can share its successes, whether at the state level or to relevant communities in other countries.
So far, it is evident that for America to address its inequity in healthcare delivery, it urgently needs to address poverty and structural racism, particularly in the NEMT subdivision of this concern. To do this feat, medical institutions may have to immediately find innovative ways to leverage communication and technology to resolve transportation issues around patient health appointments.
- Hutchinson, M. and Bedrosian, S. (2021) “Health Literacy and Health Equity: Connecting the Dots” retrieved on 12-11-2021, from Reference URL.
- Nash (2021), “Social Determinants Pave the Road to Health Equity” retrieved on 12-11-2021, from Reference URL.
- Wigginton, S. (2021) “5 ways health plans are addressing health equity” retrieved on 12-11-2021 from Reference URL.