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Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA

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  • Matthew Lee Smith

    (College of Public Health, The University of Georgia, Athens, GA 30602, USA
    Texas A&M School of Public Health, Texas A&M University, College Station, TX 77844, USA)

  • Thomas R. Prohaska

    (College of Health and Human Services, George Mason University, Fairfax, VA 22030, USA)

  • Kara E. MacLeod

    (Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA)

  • Marcia G. Ory

    (Texas A&M School of Public Health, Texas A&M University, College Station, TX 77844, USA)

  • Amy R. Eisenstein

    (Feinberg School of Medicine, Northwestern University, Chicago, IL 60209, USA)

  • David R. Ragland

    (School of Public Health, University of California, Berkeley, CA 92521, USA
    SafeTREC, University of California, Berkeley, CA 92521, USA)

  • Cheryl Irmiter

    (Easter Seals, Chicago, IL 91106, USA)

  • Samuel D. Towne

    (Texas A&M School of Public Health, Texas A&M University, College Station, TX 77844, USA)

  • William A. Satariano

    (School of Public Health, University of California, Berkeley, CA 92521, 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.

Suggested Citation

  • Matthew Lee Smith & Thomas R. Prohaska & Kara E. MacLeod & Marcia G. Ory & Amy R. Eisenstein & David R. Ragland & Cheryl Irmiter & Samuel D. Towne & William A. Satariano, 2017. "Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA," IJERPH, MDPI, vol. 14(2), pages 1-13, February.
    • Handle: RePEc:gam:jijerp:v:14:y:2017:i:2:p:174-:d:89927
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    References listed on IDEAS

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    Cited by:

    1. Matthew Lee Smith & Samuel D. Towne & Angelica Herrera-Venson & Kathleen Cameron & Kristie P. Kulinski & Kate Lorig & Scott A. Horel & Marcia G. Ory, 2017. "Dissemination of Chronic Disease Self-Management Education (CDSME) Programs in the United States: Intervention Delivery by Rurality," IJERPH, MDPI, vol. 14(6), pages 1-14, June.
    2. Marcia G. Ory & Matthew Lee Smith, 2017. "What If Healthy Aging Is the ‘New Normal’?," IJERPH, MDPI, vol. 14(11), pages 1-5, November.

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