Sept. 19—Shortly after 9:30 am, Nayelli Andrade and her mom, Angelica Munoz, got off the route 349 Pace bus across from the Cook County Blue Island Health Center.
They live in Washington Heights, near Halsted and 103rd streets in Chicago, Andrade said. They took the route 103 to the route 349 Monday to get to the health center for Munoz to get some blood work done, Andrade said.
Taking the bus from Halsted and 103rd could take anywhere from 30 minutes to 45 minutes, Andrade said, but the worst part of the ride is waiting for the bus.
“It was convenient. The only issue was the app saying it’ll be here and it wasn’t,” Andrade said.
Munoz said she is nervous about taking the bus to the clinic because it can be unpredictable. For example, a few months ago, they had to take a ride share car to an appointment because the bus was running late, Munoz said.
“I get nervous we’ll miss sometimes,” she said.
Lindsay Allen, assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine, researches access to health care for Medicaid recipients, who typically are marginalized members of society. Within that research, Allen said she focuses on how patients decide where to seek care for nonemergency care and substance use disorder care.
Research has found a lack of transportation results in delayed or missed health care appointments, poorer health outcomes and increase in health care expenses, Allen said.
If a trip on public transportation to a health care center takes more than an hour and a half, Allen said, it constitutes a lack of transportation.
“Just because it exists doesn’t mean it’s actually useful,” Allen said. “Not having access to transportation does worsen people’s health and increase health care costs.”
Pace’s “primary goal is to provide connectivity,” and the transportation company understands that some routes take a longer time, spokeswoman Maggie Daly previously said. Pace officials are frequently reviewing routes and working with community members to make improvements, she said.
Handicap Pace bus shuttles frequently stopped outside the Blue Island health center Friday and Monday.
The Cook County health system also has a fleet of vehicles that can take patients within Cook County to their medical appointments, said Iliana Mora, chief administrative officer for Cook County Health’s Ambulatory Services Patients can call 312-864-7433 to schedule a trip, she said.
A lack of transportation also results in people calling for an ambulance and going to the emergency room for non-emergency care, Allen said. It’s extremely expensive to use an ambulance, she said.
Wealthy people who have health insurance and a car have the best access to health care because they have a large option of health care providers to choose from and they can drive to their appointments, Allen said.
For lower income individuals, the issue of health care access goes beyond “cars are expensive and not feasible,” Allen said.
Lower income individuals, who likely have Medicaid, have a smaller pool of clinicians to see, Allen said. The clinicians who accept Medicaid tend to be spread out, so patients have to then travel farther by public transportation to get there.
But health care access is deeper than traveling to the appointment, Allen said.
“The thing that people are not considering is that it’s not just about getting to the appointment. It’s everything that you have to give up in order to spend an hour and a half one way to get to that clinic,” Allen said.
Three hours of travel means additional money spent on child or elder care, three hours of time off from work and three hours exposed to potential safety risks, like routes through dangerous neighborhoods.
Studies have also found that Black people, low-income individuals and women use public transportation to commute, Allen said, and those same groups of people have health inequities.
“We are worsening health equity by making certain groups rely on public transportation,” Allen said.
Expanding Telehealth would help bring health care to those who need it, Allen said. But, the other side of that issue, she said, is that lower income individuals may have less access to broadband.
The way to improve access to Telehealth is to have a digital navigator to help those who have lower technological literacy, Allen said.
Mobile clinics would help people avoid having to travel three hours a day to get the care they need, Allen said. The health care system could also tap into the ride share infrastructure to pay for a car ride to a health clinic as opposed to paying for an ambulance ride to the emergency room, she said.
“It would be much cheaper for somebody to reimburse a Lyft than to reimburse an emergency room visit. Let’s get patients in Lyft’s to their primary care provider or to an urgent care center or to a regional clinic, something that’s much less costly than care setting having them rely on potentially an expensive ambulance to get to an emergency room,” Allen said.
Andrade and Munoz, who used a day off to go to Monday’s appointment, have taken a ride share car to the clinic before, which costs about $25. If people could prove they took the ride share car to a clinic, Andrade said it would be a great way to expand health care access.
To improve access, Allen said there needs to be a shift in thinking that health care starts and stops within the doctor’s office.
For example, when decisions are made about public transportation routes, it affects people’s access to health care, Allen said. Or, a workplace policy, such as granting employees time off to get vaccinations or for doctor’s appointments, could be a corporate policy that directly affects health, she said.
“Thinking of health care and thinking of access to health care as starting well before the patient arrives in the doctor’s office, I think is a critical mindset shift that we need,” Allen said.
With these solutions in place, Allen said people would more likely visit their primary care providers for check ups rather than only when sick.
“We want a truly health care system where people are engaging in preventive care over time, and what that does is help keep people healthier over the life span,” Allen said.
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