The public health case for addressing transportation-related barriers to care

The many ways in which the US health care system does not fully meet the needs of the population are well documented. Issues abound in health care encounters, but problems with the system are most pervasive when people cannot even get inside the door. Access to care, encompassing availability, accommodation, affordability, acceptability, and accessibility, is an enormous challenge in the United States, with its fragmented system of payers, providers, and types of care. An inordinate amount of time is spent thinking about how to improve access to care by expanding insurance coverage and reducing out-of-pocket costs. Yet, it is equally important to consider the basic mechanics of how people get to health care settings, an essential component of physical accessibility to care. In this issue of AJPH, Wolfe et al. (p. 815) show that millions of Americans delay health care every year simply because they do not have the transportation to get to the doctor’s office. Despite all of the efforts to improve access to care and address social determinants in recent years, the percentage of Americans with transportation-related barriers to care did not change between 1997 and 2018, stubbornly holding fast at 1.8%. As the US population has grown, the number of people affected by transportation barriers to care has risen from 4.8 to 5.8 million annually.