Shortly after 9:30 a.m., Nayelli Andrade and her mother, Angelica Munoz, got off the 349 Pace bus in front of the Cook County Blue Island Health Center.
They live in Washington Heights, near Halsted and 103rd Street in Chicago, Andrade said. They took Route 103 to Route 349 on Monday to go to Munoz Health Center for blood work, Andrade said.
Taking the bus from Halsted and 103rd can take 30 to 45 minutes, Andrade said, but the worst part of the journey is waiting for the bus.
“It was convenient. The only problem was the app said it would be there and it wasn’t,” Andrade said.
Munoz said she was nervous about taking the bus to the clinic as it can be unpredictable. For example, a few months ago they had to take a rideshare car to an appointment because the bus was late, Munoz said.
“I get nervous, we’re going to miss sometimes,” she said.
Lindsay Allen, assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine, studies access to health care for Medicaid recipients, who are typically marginalized members of society. As part of this research, Allen said she focused on how patients decide where to seek care for elective care and care for substance use disorders.
The research found a lack of transportation results in delayed or missed health care appointments, poorer health outcomes and increased health care spending, Allen said.
If a public transit trip to a health center takes more than an hour and a half, Allen said, that constitutes lack of transportation.
“Just because it exists doesn’t mean it’s actually useful,” Allen said. “Lack of access to transportation worsens people’s health and increases the cost of health care.”
“Pace’s main purpose is to provide connectivity,” and the transit company understands that some routes take longer, spokeswoman Maggie Daly previously said. Rhythm managers frequently review routes and work with community members to make improvements, she said.
Handicap Pace bus shuttles stopped frequently outside the Blue Island Health Center on Friday and Monday.
The Cook County Health System also has a fleet of vehicles that can take Cook County patients to medical appointments, said Iliana Mora, executive director of ambulatory services for Cook County Health. Patients can call 312-864-7433 to schedule a trip, she said.
A lack of transportation is also causing people to call an ambulance and go to the emergency room for non-urgent care, Allen said. It is extremely expensive to use an ambulance, she said.
Wealthy people who have health insurance and a car have the best access to health care because they have a wide choice of health care providers and can drive to their appointments, Allen said. .
For low-income people, the issue of access to health care goes beyond “cars are expensive and unfeasible,” Allen said.
Lower-income people, who likely have Medicaid, have a smaller pool of clinicians to see, Allen said. Clinicians accepting Medicaid tend to be dispersed, so patients must travel farther by public transportation to get there.
But access to health care goes deeper than just getting to appointments, Allen said.
“What people don’t consider is that it’s not just about getting to the appointment. That’s all you have to give up to spend an hour and a half one way to get to this clinic,” Allen said.
Three hours of travel means extra money spent on child or elder care, three hours away from work, and three hours exposed to potential safety hazards, such as routes through dangerous neighborhoods.
Studies have also found that black people, low-income people and women use public transit to get around, Allen said, and those same groups of people suffer from health inequities.
“We’re worsening health equity by forcing certain groups to rely on public transportation,” Allen said.
The expansion of telehealth would help bring health care to those who need it, Allen said. But, the other side of this issue, she said, is that low-income people may have less access to broadband.
The way to improve access to telehealth is to have a digital navigator to help those with low tech literacy, Allen said.
Mobile clinics would help people avoid having to travel three hours a day to get the care they need, Allen said. The health system could also tap into ride-sharing infrastructure to pay for a car ride to a health clinic instead of paying for an ambulance ride to the emergency room, she said.
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“It would be a lot cheaper for someone to reimburse a Lyft than to reimburse an ER visit. Let’s get Lyft patients to their primary care provider or an urgent care center or regional clinic, which is a much less expensive care setting than having them rely on a potentially expensive ambulance to get there to the ER,” Allen said.
Andrade and Munoz, who took the day off to go to Monday’s appointment, have already taken a rideshare car to the clinic, which costs about $25. If people could prove they took the carpool to a clinic, Andrade said that would be a great way to expand access to health care.
To improve access, Allen said there needs to be a change in the way of thinking that health care begins and ends in the doctor’s office.
For example, when decisions are made about public transit routes, it affects people’s access to health care, Allen said. Or, a workplace policy, such as giving employees time off to get vaccinated or for doctor’s appointments, could be a company policy that directly affects health, he said. she stated.
“Thinking of healthcare and thinking of access to healthcare as beginning long before the patient arrives at the doctor’s office, I think that’s a critical mindset shift that we need,” he said. Allen said.
With these solutions in place, Allen said people are more likely to visit their primary care providers for checkups rather than just when sick.
“We want a real health care system where people engage in preventative care over time, and what that does is help keep people healthier throughout life,” Allen said.
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