The road to access: Addressing transportation challenges in rural primary care

Central Appalachia's coal fields are the site of health disparities influenced by social determinants of health including poverty and isolation, compounded by transportation barriers to health care. In this study, we conducted two surveys among patients at a rural federally qualified health center (FQHC) to evaluate the health and financial ramifications of transportation barriers to primary care. Our findings indicate that patients facing transportation barriers rely disproportionately on emergency department services or hospitalization. Most notably, we found that Medicaid beneficiaries, theoretically eligible for no- cost, non- emergency medical transportation (NEMT), often resort to paying for transportation to office visits. Patients, especially Medicaid beneficiaries, who are financially burdened by transportation costs exhibit higher likelihood of requiring emergency department services or hospitalization. Our study underscores the potential benefits of investing in NEMT services, with the potential to reduce health care spending by mitigating reliance on emergency care and hospitalization while increasing equitable access to care.