title: Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA.
abstract: Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas.Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation.Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas.Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients.
authors.affiliation: College of Public Health, The University of Georgia, Athens, GA 30602, USA. health@uga.edu.|Texas A&M School of Public Health, Texas A&M University, College Station, TX 77844, USA. health@uga.edu.
authors.forename: Matthew Lee
authors.initials: ML
authors.lastname: Smith
authors.affiliation: College of Health and Human Services, George Mason University, Fairfax, VA 22030, USA. tprohask@gmu.edu.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Prohaska
authors.affiliation: Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA. kara.e.m@gmail.com.
authors.forename: Kara E
authors.initials: KE
authors.lastname: MacLeod
authors.affiliation: Texas A&M School of Public Health, Texas A&M University, College Station, TX 77844, USA. mory@sph.tamhsc.edu.
authors.forename: Marcia G
authors.initials: MG
authors.lastname: Ory
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, IL 60209, USA. amy.eisenstein@northwestern.edu.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Eisenstein
authors.affiliation: School of Public Health, University of California, Berkeley, CA 92521, USA. davidr@berkeley.edu.|SafeTREC, University of California, Berkeley, CA 92521, USA. davidr@berkeley.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Ragland
authors.affiliation: Easter Seals, Chicago, IL 91106, USA. cirmiter@sbcglobal.net.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Irmiter
authors.affiliation: Texas A&M School of Public Health, Texas A&M University, College Station, TX 77844, USA. towne@sph.tamhsc.edu.
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Towne
authors.affiliation: School of Public Health, University of California, Berkeley, CA 92521, USA. bills@berkeley.edu.
authors.forename: William A
authors.initials: WA
authors.lastname: Satariano
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology*; D003691:Delaware / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D014187:Transportation of Patients / Q000379:methods; D014505:Urban Population
keywords: United States of America; aging; healthcare access; non-emergency medical transportation; rural; transportation; travel distance