THE ROLE OF PUBLIC TRANSPORTATION IN ACCESS TO CARE FOR OLDER ADULTS IN THE UNITED STATES

Among older adults in the United States, transportation is the third most commonly cited barrier to care. Existing research on transportation as a barrier to accessing health services is limited to rural areas and access to private vehicles, yet transportation is as much a barrier to care for older adults living in urban areas. This research addresses three questions on the topic of aged Medicare beneficiaries’ use of public transportation and access to health services. First, whether there is a valid measure of access to public transport. Second, whether access to public transport is associated with its use to travel to a usual source of care. Finally, whether access to public transport is associated with more appropriate use of outpatient health services. We found that two existing measures of public transport accessibility, the Transport Connectivity Index (TCI) and the Transit Access Shed (TAS) are valid measures of public transport accessibility, both for Census block groups and ZIP Code tabulation areas (ZCTAs). Overall, approximately 5% of older adult Medicare beneficiaries take public transportation to get to their usual source of care. Additionally, individuals living in areas with better public transportation are more likely to take public transportation to get to their usual source of care, independent of the other barriers to care or health status. However, I did not find a relationship between access to public transportation and appropriate use of outpatient services. Beneficiaries living in areas with better public transportation were equally likely to have at least one primary care visit during the year, and were hospitalized for ambulatory care sensitive conditions at the same rate as beneficiaries living in areas with worse public transportation. Future research should work to understand how beneficiaries without private vehicles are getting to health services and to evaluate other transportation alternatives