We don’t commonly think of public transportation as part of health care policy, though the people who work in public health know it’s important. But maybe we should, according to a new study focused on the opening of a light-rail line in the Twin Cities.
A group of researchers from the Urban Institute, Harvard Medical School, Mass General, and the University of Minnesota studied what happened to no-show outpatient appointments at a major health system when the Green Line opened in the Minneapolis-St. Paul area in 2014, connecting those two cities’ downtowns. The new Metro line was more reliable — less susceptible to traffic jams or bad weather — and ran more frequently than the buses that had previously covered the same route.
By looking at data from before the rail line’s opening and differentiating between patients who lived near the new transportation service versus those who did not in order to establish a baseline, the authors were able to isolate the effect of the Metro line. The impact they found was significant, much more than previous studies that had attempted to measure the effects of transportation on patients’ behavior.
They found a meaningful reduction in the number of no-show appointments among patients who lived near the Green Line, with the no-show rate dropping by 4.5 percent compared to the baseline. The effect was particularly profound for Medicaid patients, who saw their no-show rate decline by 9.5 percent compared to the baseline.
The researchers also found an increase in same-day appointments for patients and clinics located near the new rail line, indicating the expanded transportation options also made it easier for people to get urgent or otherwise unplanned medical care.
Why does this improvement in attendance matter? Patients get more reliable care, which can help head off bigger health problems down the road, and providers don’t end up with a bunch of empty slots that could have been filled by other patients.
Here is how the researchers explained the significance of their findings, published in the journal Health Services Research:
Even a small decrease in no-shows benefits both patients and providers. For patients, completing appointments improves care continuity and avoids potentially harmful lapses in screening and treatment. This may be especially true for patients with chronic illness, who are also more likely to experience transportation barriers. Outpatient care can help chronically ill patients access appropriate medications, achieve better disease control, and avoid future emergency department use or hospitalizations associated with their conditions. For providers, fewer no-shows increases revenue and reduces scheduling inefficiencies.
Their study also serves as a corrective to some of the prior research on this subject. Previous studies had tried to detect any effect resulting from a mass transportation strike or the offer of ride-sharing services specifically to patients.
Neither had found much of an impact. But the first was more than 20 years old and the second dealt with a sample size of fewer than 2,000 patients.
The data set analyzed in this new study covered more than 3.5 million appointments and 370,000 unique patients. The effect they found was meaningful, especially for low-income patients (disproportionately people of color) for whom structural obstacles to health care, including transportation options, have been profound.
“By documenting a decrease in no-show appointments and an increase in same-day appointments following a public transportation expansion — especially for low-income individuals — we provide important new evidence on the importance of adequate public transportation to achieve equity in access to care,” the authors state in their conclusion.
The bipartisan infrastructure bill, now signed into law by President Joe Biden, will pump nearly $40 billion into local public transit — a nice down payment, but not enough to fundamentally change the trajectory of the US’s ailing public transit system, according to experts.
The Build Back Better Act being debated in Congress right now would provide some additional funding for public transit. But it won’t be nearly enough to address the estimated $176 billion backlog of repairs and improvements that civil engineers believe currently exists in the United States.
There are lots of reasons to invest more money in public transit. But here is one more: It makes it easier for people, particularly those living in marginalized communities, to get to their doctor. Look at what happened in Minnesota.