Shortly after 9:30 a.m., Niely Andrade and her mother, Angelica Munoz, got off by bus 349 Pace across from the Cook Blue Island County Health Center.
Andrade said they live in Washington Heights near Halstead and 103rd Streets in Chicago. Andrade said they took Route 103 to Route 349 on Monday to get to Munoz Health Center for some blood tests.
Andrade said the bus ride from Halsted and 103 could take anywhere from 30 minutes to 45 minutes, but the worst part of the trip was waiting for the bus.
“It was convenient. “The only problem was that the app said it would be there and it wasn’t,” Andrade said.
Munoz said she is nervous about taking the bus to the clinic because it might be so unexpected. A few months ago, Munoz said, for example, they had to take a shared car to an appointment because the bus was late.
“I get nervous because we miss sometimes,” she said.
Lindsey Allen, assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine, studies access to health care for Medicaid recipients, who are usually marginalized members of society. Within this research, Allen said she focuses on how patients determine where to seek care for non-emergency and substance use disorder care.
Allen said research has found that lack of transportation leads to delayed or missed health care appointments, poor health outcomes and an increase in health care expenditures.
If the trip by public transportation to a health care center takes more than an hour and a half, Allen said, that’s a transportation shortage.
“Just because it’s there doesn’t mean it’s actually useful,” Allen said. “Lack of transportation worsens people’s health and increases the cost of health care.”
Pace spokeswoman Maggie Daly said earlier that Pace’s primary goal is to provide connectivity, and the carrier recognizes that some routes take longer. She said Pace officials frequently review the methods and work with community members to make improvements.
Handicap Base buses make frequent stops outside Blue Island Health Center on Friday and Monday.
Cook County Ambulatory Services patient administrative director Eliana Mora said the Cook County health system has a fleet of vehicles that can transport patients within Cook County to their medical appointments, and they can call 312-864-7433 to schedule a flight. He said.
The lack of transportation also causes people to call an ambulance and go to the emergency room for non-emergency care, Allen said. She said it was too expensive to use an ambulance.
Allen said that wealthy people with health insurance and a car have the best access to health care because they have a large choice of health care providers to choose from and can drive to their appointments.
For low-income individuals, access to health care goes beyond “cars that are expensive and useless,” Allen said.
Allen said that low-income individuals, who are more likely to have Medicaid, have a smaller group of doctors to see. Doctors accepting Medicaid tend to be widespread, so patients have to travel farther by public transportation to get there.
Allen said access to healthcare goes deeper than traveling to an appointment.
“The thing people don’t think about is that it’s not just about getting to the appointment. It’s all you have to give up in order to spend an hour and a half on the way to get to that clinic,” Allen said.
Three hours of travel means extra money spent on child or elderly care, three hours off work and three hours exposed to potential safety hazards, such as roads through dangerous neighborhoods.
Studies also find that blacks, low-income individuals, and women use public transportation to get around, Allen said, and that these same groups suffer from health inequalities.
“We are making health equity worse by making certain groups dependent on public transportation,” Allen said.
Allen said expanding telehealth will help provide health care to those who need it. But the flip side of the issue, she said, is that low-income individuals may have less access to broadband.
The way to improve access to telehealth, Allen said, is to have a digital navigator to help those with less technological knowledge.
Allen said mobile clinics will help people avoid having to travel three hours a day to get the care they need. She said the health care system could also take advantage of ride-sharing infrastructure to pay for rides to the health clinic instead of paying for an ambulance ride to the emergency room.
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“It would be much cheaper for someone to reimburse Lyft than to reimburse an emergency room visit. Let’s get patients at Lyft’s to a primary care provider, to an urgent care center or to a regional clinic, which is much less expensive than having them rely on an expensive ambulance to get to the hospital. emergency room,” Allen said.
Andrade and Munoz, who had taken a day off to go to a Monday appointment, had taken a shared car to the clinic before, which cost about $25. Andrade said if people could prove they took the ride-sharing to a clinic, that would be a great way to expand access to health care.
To improve access, Allen said there should be a shift in thinking that health care starts and stops inside the doctor’s office.
For example, when decisions are made about public transportation methods, they affect people’s access to health care, Allen said. Or that workplace policy, such as giving employees time off to receive vaccinations or for doctor’s appointments, could be an institutional policy that directly affects health, she said.
“Thinking about health care and thinking about health care access as starting before a patient gets to the doctor’s office, I think it’s a critical mental shift that we need,” Allen said.
With these solutions in place, Allen said people are more likely to visit their primary care providers for checkups and not just when sick.
“We want a real healthcare system where people participate in preventive care over time, and what that does is help keep people healthy for life,” Allen said.