Transportation, Distance, and Health Care Utilization for Older Adults in Rural and Small Urban Areas

Transportation is vital for access to health care, especially in rural areas, where travel distances are great and access to alternative modes such as transit is less prevalent. This study estimated the impacts of transportation and travel distance on the utilization of health care services for older adults in rural and small urban areas. With data collected from a survey, a model was developed on the basis of the Health Behavior Model, which considered transportation and distance as factors that could enable or impede health care utilization. A random sample of individuals age 60 years and older living in the rural Upper Great Plains states of Montana, North Dakota, South Dakota, and Wyoming were surveyed by mail. Responses were received from 543 individuals (20% response rate). Probit models were used to estimate trip frequency and the likelihood that an individual would miss or would delay a health care trip. Distance and transportation variables were not found to influence significantly the total number of routine or chronic care trips made overall, while emergency care visits were affected by the availability of transportation options. Additional results showed that those who could not drive made more trips if someone in the household could drive and that distance and access to transportation affected the difficulty reported in making trips and the likelihood of missing or delaying a trip. The greatest problems for people using public transportation for health care trips were inconvenient schedules, the need to match transit and medical schedules, and infrequent service.