“First, you have to get there”: Access to care and transportation obstacles
Getting to appointments can be the hardest part of staying current with medical care for Kia Davis’ clients. Davis is a Community Health Worker (CHW), who cares for pregnant mothers and children through Mercy Health. Mercy Health is a partner agency of the Southwest Ohio Pathways Community HUB, which Health Care Access Now directs.
Davis has been a CHW since 2008, working with “many different programs to get them up and running.” One of her greatest past challenges was case managing pregnant women who were addicted to heroin.
With all that experience, Davis has come to recognize how not having reliable transportation can derail her clients’ health—and even cause them unnecessary problems. She also knows that the current solutions for people without transportation access need adjustment for greater efficacy.
After all, “First, you have to get there.” Without going to the medical appointment, “you won’t get the diagnosis, the help, the treatment you need. If you don’t get there, nothing else really matters.”
Why transportation can be a problem
Many of Davis’ clients simply don’t have the resources for car ownership. “Lots of them don’t even have a driver’s license.” While her clients may have extensive emotional support systems, many of them “come from generational poverty, which means that none of the people in their life may have [personal] transportation.” Those clients can’t rely on family to provide rides to health appointments.
There are options for those who can’t access care through personal transportation, many of which are offered through Managed Care Organizations (MCOs). One way is through MCO-contracted rides to and from appointments—which can lead to difficulties that don’t affect those with personal vehicles.
For example, “if a [pregnant woman] starts bleeding in the morning and the doctor says she has to come in that day, she may call for transport and be told they need 48 hours advance notice,” Davis says. That could mean the client has to call an ambulance instead.
The entire process of setting up MCO-contracted transport can be exasperating, Davis says, because there is typically no direct line to the transportation company. Usually, clients must call their insurance number “and follow difficult prompts to get connected with transportation, which can be time-consuming and cause frustration.”
MCOs also provide bus passes, but that option can take several hours out of a client’s day, and if she has multiple children that have to accompany her to the appointment, that option is less realistic. Finally, some MCOs are now also reimbursing family members for miles driven to go to appointments and the pharmacy—but if no one in the clients’ immediate circle has a car, that doesn’t work either.
Often, the clients “just don’t go. It happens a lot, unfortunately.”
Consequences for missing appointments
“I ask, ‘What is your plan? How are you going to get there? We know you have to get to the doctor. How is it going to happen?’” Davis says. “Sometimes starting with the end goal and working backwards” helps the client identify resources that can be used to reach their objective.
Missing appointments can have serious consequences, not just for the health of the mothers Davis serves, but also for their babies and children. For example, “Children’s Hospital will call Children Services” if the children don’t come for their annual physicals and get their immunizations. “It opens up a door that didn’t need to be opened,” she says, and can disturb already fragile situations.
While the adoption of teledoc services has helped to increase access to care, “sometimes a doctor just has to see you physically.” And getting there can be the hardest part.