Improving public infrastructure helps people keep medical appointments

We do not generally think of public transport as part of health policy, even though the people who work in public health know it is important. But perhaps, according to a new study, we should focus on opening a light rail line in the twin cities.

A group of researchers from the Urban Institute, Harvard Medical School, Mass General and the University of Minnesota examined what happened to no-show outpatient appointments in a major health care system when the Green Line opened in Minneapolis-St. Paul area in 2014, connecting the center of these two cities. The new metro line was more reliable – less susceptible to traffic jams or bad weather – and ran more frequently than buses that had previously run the same route.

By looking at data from before the railway line opened and distinguishing between patients who lived near the new transport service versus those who did not, to establish a baseline, the authors were able to isolate the effect of the metro line . The impact they found was significant, much more so than previous studies that had attempted to measure the effect of transportation on patients’ behavior.

They found a meaningful reduction in the number of absences among patients living near the green line, with the number of absences falling by 4.5 percent compared to baseline. The effect was particularly profound for Medicaid patients, who experienced a 9.5 percent decrease in absenteeism rates compared to baseline.

The researchers also found an increase in same-day appointments for patients and clinics near the new railway line, indicating that the expanded transportation options also made it easier for people to get emergency or otherwise unplanned medical care.

Why does this improvement in attendance matter? Patients receive more reliable care that can help stave off major health issues along the way, and providers do not end up with a lot of empty seats that could have been filled by other patients.

Here’s how the researchers explained the significance of their findings, published in the journal Health service research:

Even a small drop in absences benefits both patients and providers. For patients, completing appointments improves care continuity and avoids potentially harmful omissions in screening and treatment. This may be especially the case for patients with chronic disease who are also more likely to experience transport barriers. Outpatient treatment can help chronically ill patients access appropriate medication, achieve better disease control, and avoid future use of emergency room or hospitalizations related to their condition. For providers, fewer absences increase revenue and reduce scheduling inefficiency.

Their study also serves as a corrective to some of the previous research on this topic. Previous studies had attempted to detect any effect as a result of a mass transport strike or the provision of carpooling services specifically for patients.

None of them had found the great influence. But the first was more than 20 years old, and the second involved a sample size of less than 2,000 patients.

The data set analyzed in this new study covered more than 3.5 million appointments and 370,000 unique patients. The effect they found was meaningful, especially for low-income patients (disproportionately colored people) for whom structural barriers to health care, including transportation options, have been profound.

“By documenting a decline in absenteeism agreements and an increase in same-day agreements following an expansion of public transport – especially for low-income people – we provide important new evidence of the importance of adequate public transport to achieve equal access to care, «States the authors in their conclusion.

The two-part infrastructure law, now signed by President Joe Biden, will pump nearly $ 40 billion into local public transportation – a nice payoff, but not enough to fundamentally change the course of the U.S. ailing public transportation system, according to experts.

The Build Back Better Act, which is being debated in Congress right now, would provide some additional funding for public transportation. But that will not be close enough to address the estimated $ 176 billion backlog of repairs and improvements that civil engineers believe exist in the United States at present.

There are many reasons to invest more money in public transportation. But here’s one more: It makes it easier for people, especially those living in marginalized communities, to get to their doctor. See what happened in Minnesota.

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