travel and transportation costs for obtaining medical care

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Irs overview the deduction of medical travel expenses.

Certain expenses incurred in traveling for medical purposes are deductible for U.S. federal income tax purposes.  Internal Revenue Code Section 262(a) generally prohibits the deduction of personal or living expenses unless specifically allowed by the Code.  Section 213 allows a deduction for expenses paid for medical care to the extent that such expenses exceed 7.5 percent of adjusted gross income.  

Therefore you may deduct the cost for certain types of medical procedures obtained overseas.Medical care is defined in part as amounts paid for the diagnosis cure mitigation treatment or prevention of disease or for the purpose of affecting any structure or function of the body and for transportation primarily for and essential to medical care.  

A deduction is allowed for up to $50 per person for each night for lodging while away from home primarily for and essential to medical care if such care is provided by a physician in a licensed hospital (or in a medical care facility which is equivalent to a licensed hospital) and there is no significant element of personal pleasure recreation or vacation in the travel away from home.  

Therefore it is possible that the $50 per person deduction may be used for funds paid for room and board at a hospital or medical care clinic while obtaining healthcare overseas.A deduction is also allowed for transportation expenses of a nurse or other person who can give injections medications or other treatment required by a patient who is traveling to get medical care and is unable to travel alone.  

Section 213 specifically excludes a deduction for cosmetic surgery or other similar procedures unless the surgery or procedure is necessary to ameliorate a deformity arising from or directly related to a congenital abnormality a personal injury resulting from an accident or trauma or disfiguring disease.When combining travel for medical purposes with tourism determining the amount of the deductible portion can be problematic.  

When reviewing a taxpayer's return claiming such deductions the Internal Revenue Service will look at expenditures first as non- deductible personal expenses and allow only specifically documented medical expenses.  It is therefore important to first obtain a doctor's written statement stating the medical purpose of the trip and the necessity of the travel companion if applicable.  

All documented transportation to and from the medical destination allowable lodging expenses during treatment and recovery and hospital and physician costs would then be deductible.  Any additional costs of a vacation or pleasure nature would not be deductible.

Filing your personal income taxes each year in America can create a headache warranting its own medical care.  Fortunately Uncle Sam has created some pain relievers you can use that may reduce the amount you owe for healthcare received overseas. ‍

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I have a tax question about deducting mileage for medical care. Can I deduct mileage for medical appointments and dental visits from my tax return?

The IRS allows you to deduct mileage for medical care if the transportation costs are mainly for — and essential to — the medical care.

When deducting mileage for medical care, you can use either of these methods:

• Standard mileage rate for a personal vehicle — $0.16 per mile
• Parking fees

Actual expenses don’t include:

• Depreciation
• Maintenance
• License and registration fees

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Are Medical Travel Expenses Tax Deductible?

Transportation and travel costs are generally deductible as a medical expense if they’re needed to reach a medical treatment facility. These include travel costs to a doctor’s office, hospital, or clinic where you, your spouse, or dependents receive medical care.

Transportation costs you can deduct include:

• car expenses
• parking and toll fees
• bus, taxi, train, or plane fares
• ambulance service fees
• your expenses for accompanying your child while getting medical care, and
• the costs of a nurse or technician who can give injections, medications, or other treatment needed by you or family member while traveling to get medical care.

Your medical-related driving costs can be calculated in one of two ways: using your actual expenses, or using the standard medical mileage rate. If you use the actual expense method, you can only deduct the cost of gas and oil, and any repair costs incurred while driving for medical reasons. You cannot include depreciation, insurance, general repair, or maintenance expenses. If you use the standard medical mileage rate, you don’t deduct your actual costs for gas and oil. Instead, you may deduct 20 cents per mile you drive for medical treatment in 2019. For example, if you use the standard medical rate and drive 1,000 miles for medical treatment in 2019, you’d get a $200 deduction to add to all your other deductible medical expenses for the year. You can also deduct your parking fees and tolls. Whichever method you use, you must keep track of your mileage while driving for medical treatment. Check the IRS website for the annual standard deduction amount.

Cost of Meals

You can deduct the cost of meals at a hospital or similar facility if a main reason for being there is to get medical care. You can’t include in medical expenses the cost of meals that aren’t part of inpatient care. For example, you can’t deduct meals you pay for while traveling to a hospital or other medical facility.

Cost of Lodging

Lodging costs you incur while traveling out of town are deductible if:

• the lodging is primarily for, and essential to, medical care
• the medical care is provided by a doctor in a licensed hospital or in a medical care facility
• the lodging isn’t extravagant
• there’s no significant element of personal pleasure, recreation, or vacation in the travel away from home.

Hopefully this sheds a light on medical travel tax deductions when transporting a loved one for medical care and takes a little stress off the planning. For more detailed information, we suggest consulting a tax professional.

At TransMedCare , we specialize in non-emergency long-distance ground medical transport for the elderly and medical patients unable to travel by air or traditional vehicle. We provide the highest level of comfort and care and handle all the details so the process easy and stress free and the transfer from bed to bed is seamless. Medications and O2 are administrated as directed, and family is updated regularly on patient status and time of arrival. A family member, caregiver, and even a pet are welcome to ride along. If you have a loved one in need of non-emergency medical transportation for a distance of 300+ miles or more, we invite you to give us a call to discuss your needs at 888-984-3722 or visit our contact page .

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Can I deduct the cost of plane tickets and hotel lodging for out of state medical care?

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92 yr old mother residing retirement facility receiving "assited living" services which are additional costs above/beyond rent for lodging. Lodging cost tax deductible?

Not applicable

Medical Deductions 2019

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20 CFR § 10.315 - Will OWCP pay for transportation to obtain medical treatment?

(a) The employee is entitled to reimbursement of reasonable and necessary expenses, including transportation needed to obtain authorized medical services , appliances or supplies. To determine what is a reasonable distance to travel, OWCP will consider the availability of services, the employee 's condition, and the means of transportation. Generally, a roundtrip distance of up to 100 miles is considered a reasonable distance to travel. Travel should be undertaken by the shortest route, and if practical, by public conveyance. If the medical evidence shows that the employee is unable to use these means of transportation, OWCP may authorize travel by taxi or special conveyance.

(b) For non-emergency medical treatment, if roundtrip travel of more than 100 miles is contemplated, or air transportation or overnight accommodations will be needed, the employee must submit a written request to OWCP for prior authorization with information describing the circumstances and necessity for such travel expenses. OWCP will approve the request if it determines that the travel expenses are reasonable and necessary, and are incident to obtaining authorized medical services , appliances or supplies. Requests for travel expenses that are often approved include those resulting from referrals to a specialist for further medical treatment, and those involving air transportation of an employee who lives in a remote geographical area with limited local medical services .

(c) If a claimant disagrees with the decision of OWCP that requested travel expenses are either not reasonable or necessary, or are not incident to obtaining authorized medical services or supplies, he or she may utilize the appeals process described in subpart G of this part.

(d) The standard form designated for medical travel refund requests is Form OWCP -957 and must be used to seek reimbursement under this section. This form can be obtained from OWCP .

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Medical mileage tax deduction: tips & irs requirements.

When it comes to tracking your miles for taxes, we often talk about the mileage deduction and the mileage reimbursement. But there are other tax reasons to keep a mileage log. Let’s dive into the medical expense deduction and what role medical mileage plays. We’ll also discuss who can take this deduction, as well as what records you have to keep.

What is Medical Expense Deduction?

The IRS lets you deduct medical expenses only if the amount is more than 10% of your adjusted gross income (AGI). If you or your spouse were born before January 2, 1951, you can deduct medical and dental expenses that are more than 7.5% of your AGI.

The IRS defines “medical expenses” as the costs of diagnosing, curing, mitigating, treating or preventing diseases. It also includes the costs for “treatments affecting any part or function of the body.” You can’t include the costs of things that are beneficial to general health like vitamins or a vacation.

You can include the medical expenses you pay for yourself on the medical expense deduction. You can also include the costs for a spouse or your dependent. The latter only applies if they were a spouse or dependent at the time the services were provided or when you paid for them.

There is a giant list of medical expenses that you can deduct. This can lead to a sizable deduction. For this post, we’ll focus on transportation, medical mileage and car costs.

Transportation Costs on the Medical Expense Deduction

The IRS allows you to include your transportation costs that are primarily for and essential to medical care. You can include:

• Bus, train, taxi, plane fares or ambulance services
• Transportation expenses of a parent who must go with a child
• Transportation expenses for visits to see a mentally ill dependent. The IRS allows this if the visits are a recommended part of treatment.
• Transportation expenses of a nurse or other person who can give treatments required by the patient who is traveling is unable to travel alone. This can include injections, medications and more.

You can include the cost of special medical equipment for your car. This could include the cost of special hand controls or anything else installed in the car for use by a person of disability. You can also include the difference between the cost of a regular car and a car specially designed to hold a wheelchair.

You can also deduct costs of operating your vehicle for health care, which we’ll dive into below.

IRS Medical Mileage on the Medical Expense Deduction

Much like the mileage deduction, you can use two methods to calculate car-related expenses for this deduction.

The actual expense method lets you include out-of-pocket expenses like gas and oil. For the medical expense deduction, you can’t include depreciation, insurance, maintenance or general repair expenses.

You can also use the standard mileage rate of 19 cents per mile (for 2016) to calculate your medical mileage portion. For both methods, you can include parking fees and tolls. Which method should you use? I’m not a tax professional but your best bet is to calculate both and use the one that gives you a larger deduction. Let’s say Jenny drove 2,800 miles for medical reasons in 2016. She spent $400 for gas, $30 for oil and $100 on parkings and tolls. Her car expenses part of the medical expenses deduction using the actual expense method is $630 ($400+$100+$30 = $530).

To calculate the medical mileage part, multiply 2,800 by .19 cents for $532. Then, add the $100 in parking and tolls for a total of $632.

Your results will vary based on local gas prices, so it’s vital to keep track of all your drives. Just like with other deductions, you’ll need accurate documentation if you face an audit.

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IRS Medical Mileage Rate Over Time

The IRS periodically adjusts the medical mileage rate over time based on a variety of factors. Here’s how the rate has changed over time:

Transportation Costs You Can’t Include With This Deduction

There are some transportation costs you can’t include in the medical expense deduction. Those include:

• Going to and from work, even if your condition requires an unusual means of transportation
• The costs of operating a specially equipped car for other than medical reasons
• Travel for purely personal reasons to another city for medical care or an operation
• Travel meant for general improvement of one’s health.

These seem straightforward but let’s unpack the last one. If your doctor tells you to get more exercise and you drive hours to hike, you can’t include those on your medical mileage.

How to Claim Mileage for Medical Expenses on Taxes

You can deduct your medical and dental care costs on the Schedule A (Form 1040) for the year you’re filing the tax return for. You can still claim the deduction for previous years if you’re eligible and didn’t take the write off. To do this, you can file Form 1040X, Amended U.S. Individual Income Tax Return, for the year you want to claim. Do not combine multiple years’ worth of medical expense deductions on a single return.

If you didn’t claim a medical or dental expense that would have been deductible in an earlier year, you can file Form 1040X, Amended U.S. Individual Income Tax Return, for the year in which you overlooked the expense. Don’t claim the expense on this year’s return.

In general, the IRS says “an amended return must be filed within 3 years from the date the original return was filed or within 2 years from the time the tax was paid, whichever is later.”

As always, consult with your tax professional before taking the medical expense deduction. You can also learn more from on the IRS website.

Medical Mileage Log Requirements

Like with business miles, the IRS doesn’t just take your word for your medical miles. You need documentation of these trips in the form of a mileage log.

Your mileage log should include a record of:

• your mileage
• the dates of your medical trips
• the places you drove for medical purposes
• the medical purpose for your trips.

You don’t have to include this log when you take the medical deduction. But, if you ever face an IRS audit, you’ll need to back up your deductions with proof. Without proof, the IRS can deny your deduction after the fact and impose penalties.

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Traveling Towards Disease: Transportation Barriers to Health Care Access

Samina t. syed.

Section of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, 1819 W. Polk Street, M/C 640, Chicago, IL 60612, USA

Ben S. Gerber

Jesse Brown Veterans Affairs Medical Center, Chicago, IL 60612, USA

Institute for Health Research and Policy, University of Illinois at Chicago, MC 275, 454 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608, USA

Lisa K. Sharp

Institute for Health Research and Policy, University of Illinois at Chicago, MC 275, 463 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608, USA

Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.

Introduction

Transportation is a basic but necessary step for ongoing health care and medication access, particularly for those with chronic diseases ( Fig. 1 ). Chronic disease care requires clinician visits, medication access, and changes to treatment plans in order to provide evidence-based care. However, without transportation, delays in clinical interventions result. Such delays in care may lead to a lack of appropriate medical treatment, chronic disease exacerbations or unmet health care needs, which can accumulate and worsen health outcomes [ 1 , 2 ].

Model of relationship between transportation, health care access and outcomes

Patients with transportation barriers carry a greater burden of disease which may, in part, reflect the relationship between poverty and transportation availability [ 3 ]. As a result, understanding the relationship between transportation barriers and health may be important to addressing health in the most vulnerable who live in poverty.

Transportation is often cited as a major barrier to health care access [ 4 – 35 ]. Studies have found transportation barriers impacting health care access in as little as 3 % or as much as 67 % of the population sampled [ 25 , 36 ]. The wide variability in study findings makes it difficult to determine the ultimate impact that transportation barriers have on health.

This review summarizes and critically evaluates the empirical evidence on transportation barriers to health care access for primary and chronic disease care. For each of the 61 studies reviewed, we evaluated the population characteristics, methods, measures of transportation barriers and results ( Table 1 ). Results are organized into three sections: (1) measurement of transportation barriers, (2) transportation barriers and demographic differences, and (3) measurement of the impact of transportation barriers. Additionally, we define a research agenda based on gaps in the literature and discuss potential intervention opportunities and public policy considerations.

Studies on transportation barriers to health care access

We searched for peer-reviewed studies that addressed transportation barriers in relation to ongoing health care access. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. Articles dealing with access to prenatal care, emergency or acute care, or exclusive attention to general screening and prevention were excluded as they may represent a single visit or limited time period of care.

We used PubMed with the following keyword search terms (number of articles returned): transportation barriers (963), transportation barriers clinic (129), transportation barriers pharmacy (13), transportation barriers hospital (183), transportation barriers doctor (69), transportation barriers health access (276), and transportation barriers chronic disease (33). Medical Subject Heading (MESH) terms included health services accessibility AND transportation (575). Additional background information was found using the terms transportation barriers health access to search Web of Science and Psych Info, and transportation barriers to search The New York Academy of Medicine Library’s Grey Literature Report.

Abstracts were reviewed for inclusion criteria, and if necessary, full text articles were also reviewed. A secondary review of bibliographies was also conducted. In the final review, 61 articles met the inclusion criteria. The search was concluded in December 2012.

Measures of Transportation Barriers

Vehicle access and mode of travel.

Nine studies assessed the influence of vehicle access upon access to health care, and all found a positive relationship [ 24 – 26 , 37 – 42 ]. Vehicle access refers to either owning a car or having access to a car through a family member or friend. Arcury et al. [ 37 ] studied the relationship of transportation to health care utilization in 1,059 rural Appalachians and found that people who knew someone who regularly provided rides to a member of their family had a greater utilization of health care (Odds Ratio, OR 1.58). Those with a driver’s license, independent of other factors, also had greater health care utilization (OR 2.29).

Guidry et al. [ 26 ] surveyed 593 cancer patients throughout Texas, and found 38 % of whites, 55 % of African Americans, and 60 % of Hispanics identified poor access to a vehicle as a barrier that could result in missing a cancer treatment.

A study by Salloum et al. [ 38 ] looked retrospectively (2000–2007) at 406 cancer patients to see if patients were more or less likely to receive first line chemotherapy based on their demographics. Patients who were significantly less likely to receive first line chemotherapy lived in neighborhoods that had a higher percentage of households without any vehicle. Distance to the nearest chemotherapy facility was not a significant factor.

Rask et al. [ 40 ] studied obstacles to care for 3,897 urban, low socioeconomic status (SES) adults in Atlanta and found that walking or using public transportation to receive medical care was an independent predictor of not having a regular source of care (OR 1.44). Patients who did not use private transportation were also more likely to delay care (OR 1.45).

Flores et al. studied 203 children’s caretakers and found that 21 % of inner-city children faced transportation barriers to timely health care. Of these, 62 % cited lack of a car as the specific barrier, which exceeded other reasons including excessive distance, expense, or inconvenience of public transportation [ 24 ].

Two studies reported that 25 % of patients missed an appointment due to transportation problems [ 41 , 42 ]. Yang et al. [ 41 ] studied 183 urban caregivers from Houston and their children’s missed appointments, finding that an inability to find a ride resulted in at least one missed appointment for 25 % of the sample. The study also found that 82 % of those who kept their appointments had access to a car, compared to just 58 % of those who did not keep their appointments. Similarly, in a study of 698 low-income adult patients, Silver et al. [ 42 ] found that 25 % of missed appointments/rescheduling needs were due to transportation problems and bus users were twice as likely to miss their appointments compared to car users.

One study investigated transit accessibility to health care by either public transit or by foot in various low income counties in the Bay Area [ 43 ]. Results revealed that transit accessibility to a hospital, defined as getting to a hospital or clinic in 30 min or less by public transit or ½ mile by foot, varied from 0 to 28 %. Additionally, 55 % of missed appointments or late arrivals were due to transportation problems.

Collectively, these studies suggest that lack or inaccessibility of transportation may be associated with less health care utilization, lack of regular medical care, and missed medical appointments, particularly for those from lower economic backgrounds.

Urban and Rural Geography

Urban and rural locations often differ in transit options, cost of transit, and availability of and distance to health care providers. Despite this, results were mixed in the four studies that compared the impact of transportation barriers on health care access for urban and rural residences [ 14 , 44 – 46 ]. Blazer et al. [ 14 ] surveyed 4,162 urban and rural adults over 65 in North Carolina to investigate why patients delayed or neglected to see a doctor. The study showed no difference between urban and rural adults in either their use of health services or identification of transportation barriers. Similarly, a study by Skinner et al. [ 46 ] included 38,866 households, and found no difference in reports of delayed care between urban and rural parents after controlling for SES.

In contrast, three studies found that rural patients face greater transportation barriers to health care access than their urban counterparts [ 44 – 46 ]. Rural patients reported more problems with transportation and travel distance to health care providers and had a higher burden of travel for health care when measured by distance and time traveled [ 45 ]. In a study by Sarnquist et al. [ 47 ] that did not make urban comparisons, but included 64 rural, adult HIV patients, 31 % were lacking transportation and 37 % were missing appointments due to transportation problems.

Travel Burden by Time and Distance

Nine studies evaluated distance as a barrier to health care access with mixed results [ 25 , 26 , 48 – 54 ]. Six found that distance was a barrier to care [ 25 , 26 , 48 – 51 ]. Of those, five investigated a variation of the question, ‘Is distance a barrier to health care access?’, to measure the impact of distance [ 25 , 26 , 48 – 50 ]. The sixth study explored the association between distance to providers and patient reported health care utilization [ 51 ]. In contrast, two studies found that distance to a provider was not associated with differences in health care utilization [ 53 , 54 ]. Surprisingly, one study by Lamont et al. [ 52 ] found that a longer distance to one’s health care facility was associated with improved health care access. Two studies looked at the relationship of distance to either medication use or clinical outcomes, reporting that longer driving distances from one’s physician are associated with less insulin use or poorer glycemic control independent of social, clinical or economic factors [ 53 , 54 ].

Transportation Barriers and Demographic Differences

Transportation barriers and ethnic differences.

Of six studies comparing transportation barriers to health care access across ethnic groups, five found differences [ 3 , 20 , 26 , 45 , 55 , 56 ]. To understand whether ethnic differences independently account for differences in transportation barriers, socioeconomic factors must be considered because they can influence transportation variables [ 57 ].

Three studies used national data sets to explore transportation barriers to health care access in minorities, and all controlled for SES [ 3 , 20 , 45 ]. A large secondary analysis of National Health Interview Survey (NHIS) data, Medical Expenditure Panel Survey (MEPS) data, and Bureau of Transportation Statistics (BTS) data, by Wallace et al. [ 3 ], estimated that 3.6 million people do not obtain medical care due to transportation barriers. These individuals were more likely to be older, poorer, less educated, female, and from an ethnic minority group. Individuals carrying the highest burden of disease also faced the greatest burden of transportation barriers. In the second study, Johnson et al. [ 20 ] analyzed NHIS data from 1997 to 2006 to compare reasons for delayed health care access between 34,504 American Indian/Alaskan Natives and White Veterans, and found that American Indian/Alaskan Natives were more likely to delay care due to transportation problems.

A third study by Probst et al. [ 45 ] utilized a cross-sectional household survey, conducted by the US Department of Transportation, to look at ethnic differences in burden of travel for health care. Burden of travel was measured as greater than 30 min or 30 miles to a health care provider. Distance traveled did not vary significantly, but African Americans had higher burdens of travel as compared to Whites even after controlling for mode of travel and SES. In contrast, a study by Borders et al. [ 55 ] controlled for SES and found no significant difference in transportation barriers between rural Hispanics and Whites accessing health care in Texas.

Finally, two additional studies found differences by ethnicity, although they did not control for SES. In a study of 593 adults with cancer, Guidry et al. [ 26 ] found that Hispanics’ transportation barriers to cancer treatment were greater than those of African Americans, and African Americans’ barriers were greater than Whites. Transportation barriers included distance to treatment center, access to a vehicle, and finding someone to drive them to treatment. Call et al. [ 56 ] contrasted barriers to health care access between 1,853 American Indians and Whites enrolled in the Minnesota Health Care program. The study found that 39 % of American Indians reported transportation barriers compared to 18 % of Whites.

Overall, studies that explored health care access and transportation barriers among members of ethnic minorities and Whites suggested that access is superior for Whites even after controlling for SES.

Special Populations: Children, the Elderly, and Veterans

Certain populations may face unique circumstances with transportation barriers to health care access. For children, significant transportation barriers to health care access have been repeatedly identified [ 15 , 24 , 34 , 39 , 41 , 48 , 58 , 59 ]. In two separate studies of inner-city children, 18–21 % of respondents cited transportation barriers as the reason for not bringing a child in for needed health care [ 15 , 24 ]. Among migrant farm workers, 80 % cited lack of transportation as the primary reason for the last episode that their child faced an unmet medical need [ 34 ].

The elderly may face a unique combination of access barriers due to disability, illness and likely a greater need for frequent visits to their clinician. Among the elderly reporting any barrier to health care access, 3–21 % reported having transportation barriers, although insurance status and income varied among studies [ 9 , 14 , 36 , 55 , 60 – 62 ]. Additional studies of more low-income elderly may be necessary to clarify the role of transportation barriers to health care access.

Two studies examined transportation barriers to health care access for Veterans, a group that often has access to the federal health care system and may receive federally supported transportation assistance. In one study, 19 % of Veterans with colorectal cancer had difficulty with transportation to appointments, and a second study found that 35 % of female Veterans over age 65 had transportation barriers to health care access [ 23 , 63 ].

Measuring the Impact of Transportation Barriers

Missed clinic appointments.

Two studies selected patients for research specifically because of missed health care appointments to identify the reasons. In one study of 200 children with a history of missed appointments, 51 % parents identified transportation barriers as the primary reason for missing clinic appointments [ 42 ]. In another study, Yang et al. [ 41 ] surveyed 183 caregivers of urban children in Texas, and grouped patients based on show rates for a single appointment over a 9-week period. There was a 26 % no show rate overall. For those with a history of missed appointments, 50 % cited transportation problems compared to 30 % of those who kept appointments. Factors associated with missed appointments included not owning a car and not having access to a car.

Pharmacy and Medication Access

Five studies explored the relationship between transportation barriers and medication access with all reporting an inverse association [ 27 , 64 – 67 ]. Kripalani et al. [ 64 ] studied patterns of discharge medication fills in 84 adults living in urban Atlanta. The study found that following hospital discharge, patients reporting difficulty visiting the pharmacy had lower prescription fill rates than those not reporting difficulty (20 vs. 55 % respectively). Additionally, 65 % of patients felt transportation assistance would improve medication use after discharge. Musey et al. [ 27 ] examined the causes for 56 diabetic ketoacidosis [DKA] admissions at Grady Memorial Hospital in Atlanta. He found that 67 % of DKA admissions were related to stopping insulin and 50 % of those patients cited either lack of money for insulin or for transportation to get their medicine.

Welty et al. [ 65 ] created an online survey through epilepsy.com to study the relationship between transportation barriers and anti-epileptic use. The study included 143 web site members and found that 45 % of respondents who could not drive said they would miss fewer doses of their medications if transportation was not a problem.

Tierney et al. [ 66 ] examined the relationship between transportation policy and health care utilization in a cohort study of 46,722 Medicaid patients, and found that restriction of Medicaid payments for transportation resulted in decreased medication refills. A study by Levine et al. [ 67 ] found that transportation barriers were associated with not being able to afford medications, emphasizing that those with low incomes are often the hardest hit by all barriers, including transportation.

Natural Experiments

Two studies have looked at natural experiments to provide real-world insight on the impact of transportation barriers on access to care [ 66 , 68 ]. One retrospective study by Pheley et al. [ 68 ] examined the impact of a 2-week mass transit strike on missed appointments at an inner-city clinic serving a low-income population in Minneapolis. There was no difference in the number of missed appointments between strike and non-strike periods with doctors, but there was an increase of 4.7 failed appointments per 100 scheduled nurse visits (relative risk 1.17).

Another study by Tierney et al. [ 66 ] looked at a Medicaid cohort to examine the impact of a policy change that restricted Medicaid payments for transportation on health care utilization. The study focused on the 6-month pre-policy period and the 6-month post-policy period for 46,722 Medicaid patients using an inner-city public hospital and associated clinics. Results revealed that visits to community clinics increased, hospitalizations increased slightly, and visits to hospital based primary care clinics, urgent care clinics, and emergency departments fell.

This literature review on transportation barriers and access to health care yielded several important findings. First, patients with a lower SES had higher rates of transportation barriers to ongoing health care access than those with a higher SES ( Table 1 ). Additionally, transportation barriers impacted access to pharmacies and thus medication fills and adherence. Finally, while distance from a patient to a provider would intuitively seem to be a barrier to health care access, the evidence is inconclusive.

Poorer populations face more barriers to health care access in general, and transportation barriers are no exception. In 25 separate studies, 10–51 % of patients reported that transportation was a barrier to health care access ( Table 1 ). This is very significant because when patients cannot get to their health care provider, they miss the opportunity for evaluation and treatment of chronic disease states, changes to treatment regimens, escalation or de-escalation of care and, as a result, delay interventions that may reduce or prevent disease complications ( Fig. 1 ).

Ultimately, transportation barriers may mean the difference between worse clinical outcomes that could trigger more emergency department visits and timely care that can lead to improved outcomes [ 22 ]. Since patients who carry the highest burden of disease face greater transportation barriers, addressing these barriers to avoid worsening health seems logical [ 3 ]. While there may be differences in transportation barriers based on ethnicity or geography, they may disappear after accounting for socioeconomic factors such as income or insurance. Additionally, studies that reported low rates of transportation barriers to health care access often did not include more vulnerable populations, such as lower income or uninsured patients.

Mixed Evidence

Some aspects of transportation barriers, such as distance, showed mixed evidence regarding the impact on health care access. Distance does not necessarily equate to travel burden and different measures of distance may alter the results. For example, studies that measured the impact of distance subjectively, by asking patients whether distance to the provider was a barrier to health care access or not, concluded it was a barrier [ 25 , 26 , 48 – 50 ]. However, other studies that objectively measured the distance between homes and health care facilities and subsequent health care utilization found distance was not a barrier [ 52 – 54 ]. A patient may live in a wealthy suburb, own several cars, and have no problem accessing health care, even at a distance. Conversely, a seemingly shorter distance for a patient who has to walk or cannot afford public transit may prove to be too far of a distance, and hence be identified as a barrier by the patient.

Special Populations

Existing studies on the elderly suggest that transportation is a less significant barrier to health care access compared to younger populations. However, these studies lacked inclusion of lower-income elderly populations and did not address concerns that may be more relevant to the elderly, such as safety and disability access. It is possible that the elderly may have fewer competing demands, such as not having to share a car with family members who need a car for work or transporting children. However, additional studies are needed with more representative samples of elderly adults before any conclusions can be drawn about transportation barriers to health care access in this population.

Traveling Forward: Interventions and Public Policy

Collaboration between health policy makers, urban planners, and transportation experts could lead to creative solutions that address transportation barriers to health care access while considering patient health, cost, and efficiency. Such collaboration could also lead to studies in areas that are lacking research, such as research on transportation policy and its impact on health outcomes outside of injury prevention [ 8 ]. These collaborations could also use prior research to guide interventions and public policy.

In the studies reviewed, access to a vehicle was consistently associated with increased access to health care even after controlling for SES. Future interventions should consider this link in addition to public transit discounts or medical transportation services. For example, there have been interventions that provide access to cars to improve access to jobs, and these programs could be used as models for providing cars to improve health care access [ 69 ].

Additionally, reimbursement for travel should be investigated further to determine the role it plays in keeping appointments and avoiding fragmented care. In Tierney’s natural experiment study, which examined the impact of lower Medicaid payments for transportation on health care utilization, several changes occurred in health care utilization rates. These included an increase in community clinic use and hospitalizations, with a decrease in visits to urgent care clinics and emergency departments [ 66 ].

New technological innovations such as telehealth may also address transportation barriers by reducing travel needs over time. Telehealth services may include video conferencing, remote monitoring, and other disease management support at a distance. One approach to providing patient-centered care is to evaluate transportation and other barriers to ongoing health care encounters, and provide telehealth services when beneficial and cost-effective. Medication access may also be improved as more services for home medication delivery become available.

Limitations

This review was restricted in scope and had several limitations. Studies with an exclusive focus on screening, prevention, and prenatal and pregnancy care were not evaluated and may have different findings. A majority of the studies used cross-sectional designs thus making cause and effect conclusions difficult ( Table 1 ). The diversity of demographic, geographic, social variables, and outcome measures also make study-to-study comparisons difficult. Efforts to generate a valid measure of transportation barriers for consistent measurement may help to perform future meta-analyses across studies. Prospective studies of local changes in transportation options may also help contribute to the evidence, and although randomized trials would help isolate the impact of transportation interventions they would be impractical to execute [ 70 ].

Additionally, the studies on transportation barriers to health care access rely largely on self-report, and lacked an exploration of whether patients were unaware of available services or assistance. While some studies investigated the impact of transportation barriers on objective outcomes such as missed appointments or medication fills, these studies were in the minority. Whether transportation barriers contribute to differences in health outcomes needs to be explored further with objective outcome measures. By demonstrating that transportation barriers lead to missed appointments, poorer medication adherence, and thus poorer diabetes or blood pressure control, transportation barriers could be more strongly linked to health access and outcomes ( Fig. 1 ).

Transportation barriers to health care access are common, and greater for vulnerable populations. The studies reviewed may help guide both the design of interventions that address transportation barriers and the choice of measures used in assessing their effectiveness. Future studies should focus on both the details that make transportation a barrier (e.g., cost, mode of travel, public transit safety, vehicle access) and objective outcome measures such as missed appointments, rescheduled appointments, delayed medication fills, and changes in clinical outcomes. Such studies would help clarify both the impact of transportation barriers and the types of transportation interventions needed. Millions of Americans face transportation barriers to health care access, and addressing these barriers may help transport them to improved health care access and a better chance at improved health [ 3 ].

Acknowledgments

We would like to acknowledge Dr. Shannon Zenk and Kathy Korytkowski for their editing and support in the preparation of this manuscript.

Contributor Information

Samina T. Syed, Section of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, 1819 W. Polk Street, M/C 640, Chicago, IL 60612, USA.

Ben S. Gerber, Jesse Brown Veterans Affairs Medical Center, Chicago, IL 60612, USA. Institute for Health Research and Policy, University of Illinois at Chicago, MC 275, 454 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608, USA.

Lisa K. Sharp, Institute for Health Research and Policy, University of Illinois at Chicago, MC 275, 463 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608, USA.

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When people with serious and chronic illnesses can’t afford to take their meds on time, it can feel like their disease is in control. Your gift goes twice as far to help them get their lives back.

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Our transportation assistance fund provides financial support to people with life-threatening, chronic, and rare diseases to access affordable and reliable transportation to and from activities that improve their overall health outcomes. 

I can now schedule physician appointments and get my prescriptions from the drugstore without the concern of ‘how will I get there’ when driving is an impossibility and there are no volunteers or family to assist. Patricia Reeser, living with multiple sclerosis

Impact of our fund

increase in medication adherence

increase in filling medications at the pharmacy 

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Removing roadblocks to health

Increase access to healthcare services.

Cost, distance, and access to transport are common barriers for why people are unable to get to their medical appointments or pharmacy. Most of our patients travel more than 10 miles to get treatment.  

For some, like Stephen Martin in North Carolina, it’s much farther. Stephen must make a 270-mile round trip each time he visits his Parkinson’s disease specialist. His story isn’t unique for many in rural America. Many rural hospitals have closed ahead of schedule over the last two years, quadrupling the amount of travel to the nearest facility. 

Whether people need to stay overnight, take a taxi, or fill up the gas tank for a long drive to their medical appointments, transportation assistance helps reduce the cost of travel for people already facing high costs of care.  

Bolster social connection and support

According to the TransitCenter , 21 percent of Americans over 65 do not drive, with the majority reporting that not driving contributes to their feelings of social isolation.     

Social isolation is a serious health risk, and 80 percent of our patients have reported spending most of their time alone, with concerns about social support. From visiting loved ones to accessing support groups, transportation assistance helps people stay connected and reduces the detrimental health impacts of isolation and loneliness. 

I live alone in a senior facility. Transportation has been a huge challenge for me to go to medical appointments as well as taking care of my personal needs. My grant from PAN has become an important source of relieving my financial burden. Lucille Lee, living in California

Improve access to groceries and meals

One-third of PAN patients have reported facing limited or uncertain access to food. The challenge increases for people who are unable to drive or don’t have someone to take them. Our transportation fund offers a way to get to and from grocery stores, markets, food banks, or community centers for a healthy meal.  

My grant saves me over $50 a month that I can use for groceries. Marilyn Goldberg, living with Gaucher’s disease

No other transportation program provides support for patients experiencing such a wide range of serious illnesses.

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Our transportation fund helps people—regardless of where they live or their ability to drive—autonomously get to services and activities that support their health. If someone can’t get to and from activities that improve their overall health outcomes, including healthcare services, social connection and support, and healthy and nutritious food, they can’t live their healthiest lives. 

Provide flexible support based on each person’s unique needs 

With financial help from their 12-month grant, patients can choose the right type of transport for their mobility needs and geographic location, from a taxi or rideshare service, to a wheelchair-supported medical transport van, or even airfare and lodging for medical appointments that are farther away. 

We give people the autonomy and dignity to choose the option that best suits their specific needs. 

At times, I have procedures that prevent me from driving afterwards. Since there is no public transportation where I live, I have been able to use Uber rides when I am unable to drive myself. Elizabeth Parrott, living with Parkinson’s disease

Offer a seamless user journey for the individual

It’s easy for patients or caregivers to apply either online or by phone, learning right away if they are approved for a grant. They will receive a pre-paid debit card authorized for eligible transportation expenses so that they have financial assistance available when and where they need it.  

With card spend limits and a fraud detection system in place, we’re providing maximum ease of use while simultaneously protecting the fund from potential misuse.  

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Key benefits of travel medical insurance

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Choosing the right travel medical insurance

How to use travel medical insurance, is travel medical insurance right for your next trip, travel medical insurance: essential coverage for health and safety abroad.

Affiliate links for the products on this page are from partners that compensate us (see our advertiser disclosure with our list of partners for more details). However, our opinions are our own. See how we rate insurance products to write unbiased product reviews.

• Travel medical insurance covers unexpected emergency medical expenses while traveling.
• Travelers off to foreign countries or remote areas should strongly consider travel medical insurance.
• If you have to use your travel medical insurance, keep all documents related to your treatment.

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The peace of mind that comes with travel insurance for the many things that could ail you while abroad is priceless. As options for travel-related insurance abound, it's essential to research, read the fine print, and act according to the specifics of your itinerary, pocketbook, and other needs.

Travel insurance reimburses you for any unexpected medical expenses incurred while traveling. On domestic trips, travel medical insurance usually take a backseat to your health insurance. However, when traveling to a foreign country, where your primary health insurance can't cover you, travel medical insurance takes the wheel. This can be especially helpful in countries with high medical care costs, such as Scandinavian countries.

Emergency medical evacuation insurance

Another benefit that often comes with travel medical insurance, emergency medical evacuation insurance covers you for any costs to transport you to an adequately equipped medical center. Emergency medical evacuation insurance is often paired with repatriation insurance, which covers costs associated with returning your remains to your home country if the worst happens. 

These benefits are for worst-case scenarios, but they might be more necessary depending on the type of trips you take. Emergency medical evacuation insurance is helpful if you're planning on traveling to a remote location or if you're traveling on a cruise as sea to land evacuations can be costly. Some of the best travel insurance companies also offer non-medical evacuations as part of an adventure sports insurance package.

It's also worth mentioning that emergency medical evacuation insurance is required for international students studying in the US on a J Visa. 

Types of coverage offered by travel medical insurance

The exact terms of your coverage will vary depending on your insurer, but you can expect most travel medical insurance policies to offer the following coverages.

• Hospital room and board
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Travel medical insurance and pre-existing conditions

Many travel insurance providers will cover pre-existing conditions as long as certain conditions are met. For one, travelers need to purchase their travel insurance within a certain time frame from when they placed a deposit on their trip, usually two to three weeks. 

Additionally, travel insurance companies usually only cover stable medical conditions, which are conditions that don't need additional medical treatment, diagnosis, or medications.

Who needs travel medical insurance?

Even the best-laid travel plans can go awry. As such, it pays to consider your potential healthcare needs before taking off, even if you are generally healthy. Even if well-managed, preexisting conditions like diabetes or asthma can make a medical backup plan even more vital.

Having what you need to refill prescriptions or get other care if you get stuck somewhere other than home could be essential to your health and well-being. That's without counting all the accidents and illnesses that can hit us when away from home.

Individuals traveling for extended periods (more than six months) or engaging in high-risk activities (think scuba diving or parasailing) should also consider a solid medical travel plan. Both scenarios increase the likelihood that medical attention, whether routine or emergency, could be needed.

In the case of travel via the friendly seas, it's also worth considering cruise trip travel insurance . Routine care will be available onboard. But anything beyond that will require transportation to the nearest land mass (and could quickly become extremely expensive, especially if you're in another country).

Like other types of insurance, medical travel insurance rates are calculated based on various factors. Failing to disclose a preexisting health condition could result in a lapse of coverage right when you need it, as insurers can cancel your policy if you withhold material information. So honesty is always the best policy.

Even the best-laid travel plans can go awry. As such, it pays to consider your potential healthcare needs before taking off, even if you are generally healthy. Making the right choice when shopping for travel medical insurance can mean the difference between a minor hiccup in your travels and a financial nightmare. 

When a travel insurance company comes up with a quote for your policy, they take a few factors into consideration, such as your age, your destination, and the duration of your trip. You should do the same when assessing a travel insurance company. 

For example, older travelers who are more susceptible to injury may benefit from travel medical insurance (though your premiums will be higher). If you're traveling for extended periods throughout one calendar year, you should look into an annual travel medical insurance plan . If you're engaging in high-risk activities (think scuba diving or parasailing), you should seek a plan that includes coverage for injuries sustained in adventure sports.

In the case of travel via the friendly seas, it's also worth considering cruise trip medical travel insurance. Routine care will be available onboard. But anything beyond that will require transportation to the nearest land mass (and could quickly become extremely expensive, especially if you're in another country).

Travel medical insurance isn't just for peace of mind. If you travel often enough, there's a good chance you'll eventually experience an incident where medical treatment is necessary.

Before you submit your claim, you should take some time to understand your policy. Your travel medical insurance is either primary (you can submit claims directly to your travel medical insurance provider) or secondary (you must first submit claims to your primary insurance provider). In the case of secondary travel medical insurance, a refusal notice from your primary insurance provider, even if it does not cover medical claims outside the US, is often required as evidence of protocol.

On that note, you should be sure to document every step of your medical treatment. You should keep any receipts for filled prescriptions, hospital bills, and anything else documenting your medical emergency.

As many people have found out the hard way, reading the fine print is vital. Most travel insurance policies will reimburse your prepaid, nonrefundable expenses if you fall ill with a severe condition, including illnesses like COVID-19. 

Still on the fence about whether or not  travel insurance is worth it ? It's worth noting that many travel insurance plans also include medical protections, so you can also protect against trip cancellations and other unexpected developments while obtaining travel medical insurance.

While short, domestic trips may not warrant travel medical insurance, it may be a good idea to insure longer, international trips. You should also consider travel medical insurance for trips to remote areas, where a medical evacuation may be expensive, and more physically tasking trips.

While shopping for travel medical insurance may not be fun, a little advance leg work can let you relax on your trip and give you peace of mind. After all, that is the point of a vacation. 

Medical travel insurance frequently asked questions

Trip insurance covers any unexpected financial losses while traveling, such as the cost of replacing lost luggage, trip interruptions, and unexpected medical expenses. Travel medical insurance just covers those medical expenses without the trip interruption or cancellation insurance.

Travel insurance companies usually offer adventure sports as add-on coverage or a separate plan entirely. You'll likely pay more for a policy with adventure sports coverage. 

Many travel medical insurance policies now include coverage for COVID-19 related medical expenses and treat it like any other illness. However, you should double-check your policy to ensure that is the case.

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eTable. Survey-Weighted Multivariable Linear Regression for Additional Travel Time (minutes) and Distance (miles) Associated With Use of Public Transportation vs Private Vehicle From Trip Originating in the Urban Setting for Health Care Visits Reported by Household Income (<$25 000; $25,000-$49,999; $50,000-$99,999; and ≥$100,000) Accounting for Respondent, Trip, and Community Characteristics

eFigure. Respondent Recruitment Flowchart

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Labban M , Chen C , Frego N, et al. Disparities in Travel-Related Barriers to Accessing Health Care From the 2017 National Household Travel Survey. JAMA Netw Open. 2023;6(7):e2325291. doi:10.1001/jamanetworkopen.2023.25291

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Disparities in Travel-Related Barriers to Accessing Health Care From the 2017 National Household Travel Survey

• 1 Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
• 2 Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
• 3 Vita-Salute San Raffaele University, Milan, Italy
• 4 Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
• 5 Division of Urology, University of Toronto, Toronto, Ontario, Canada
• 6 Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
• 7 Department of Epidemiology and Zhu Family Center for Global Cancer Prevention, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
• 8 Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
• 9 Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick

Question   What sociodemographic factors are associated with geographic barriers in accessing health care facilities in the United States?

Findings   In this cross-sectional study including 12 092 households and 15 063 respondents, non-Hispanic Black respondents and economically disadvantaged populations were more likely to use public transportation. Among respondents with an income of $25 000 to $49 999, non-Hispanic Black respondents had longer trip duration than non-Hispanic White respondents, despite a similar distance traveled.

Meaning   These findings suggest that achieving health equity in access to care will require the removal of access barriers that disproportionately affect socioeconomically disadvantaged and racially minoritized populations.

Importance   Geographic access, including mode of transportation, to health care facilities remains understudied.

Objective   To identify sociodemographic factors associated with public vs private transportation use to access health care and identify the respondent, trip, and community factors associated with longer distance and time traveled for health care visits.

Design, Setting, and Participants   This cross-sectional study used data from the 2017 National Household Travel Survey, including 16 760 trips or a nationally weighted estimate of 5 550 527 364 trips to seek care in the United States. Households that completed the recruitment and retrieval survey for all members aged 5 years and older were included. Data were analyzed between June and August 2022.

Exposures   Mode of transportation (private vs public transportation) used to seek care.

Main Outcomes and Measures   Survey-weighted multivariable logistic regression models were used to identify factors associated with public vs private transportation and self-reported distance and travel time. Then, for each income category, an interaction term of race and ethnicity with type of transportation was used to estimate the specific increase in travel burden associated with using public transportation compared a private vehicle for each race category.

Results   The sample included 12 092 households and 15 063 respondents (8500 respondents [56.4%] aged 51-75 years; 8930 [59.3%] females) who had trips for medical care, of whom 1028 respondents (6.9%) were Hispanic, 1164 respondents (7.8%) were non-Hispanic Black, and 11 957 respondents (79.7%) were non-Hispanic White. Factors associated with public transportation use included non-Hispanic Black race (compared with non-Hispanic White: adjusted odds ratio [aOR], 3.54 [95% CI, 1.90-6.61]; P  < .001) and household income less than $25 000 (compared with ≥$100 000: aOR, 7.16 [95% CI, 3.50-14.68]; P  < .001). The additional travel time associated with use of public transportation compared with private vehicle use varied by race and household income, with non-Hispanic Black respondents with income of $25 000 to $49 999 experiencing higher burden associated with public transportation (mean difference, 81.9 [95% CI, 48.5-115.3] minutes) than non-Hispanic White respondents with similar income (mean difference, 25.5 [95% CI, 17.5-33.5] minutes; P  < .001).

Conclusions and Relevance   These findings suggest that certain racial, ethnic, and socioeconomically disadvantaged populations rely on public transportation to seek health care and that reducing delays associated with public transportation could improve care for these patients.

Achieving health equity requires the removal of access barriers that disproportionately impact socioeconomically disadvantaged and racially minoritized populations, such as Black and Hispanic individuals. 1 - 4 Among these barriers, geographic access, referring to the proximity and time needed to travel from residence to facility, remains understudied relative to other dimensions of access. 5

In the US, an estimated 5.8 million individuals delay medical care every year due to transportation barriers, including lack of a private vehicle; inconvenient, unreliable, and expensive transportation; and poor road infrastructure. 6 , 7 Racially minoritized populations, patients with lower socioeconomic status, and patients with comorbidities are more likely to face transportation barriers and longer travel times for medical care. 6 , 8 Discriminatory housing policies and resulting neighborhood segregation have placed racially minoritized populations far from high-quality care and reliable transport networks. 4 , 9 , 10 Inadequate transportation can lead to missed or rescheduled appointments, delayed care, and poor medication adherence. 11 - 14

We have a limited understanding of the potential impact of transportation modes on disparities in accessing care. Black populations are 3 times and Hispanic populations are 2 times more likely to use public transportation compared with White populations. 15 These patterns align with disparities in car ownership, as 24% of Black and 17% of Hispanic households do not have a private vehicle, compared with only 7% of White households. 16 Consequently, racially minoritized households with lower incomes may face compounded disadvantages, potentially leading to worse medical outcomes. 17 , 18 For instance, neighborhoods with lower vehicle ownership are associated with higher mortality rates after myocardial infarction among Black patients, although disparities are mitigated in neighborhoods with higher rates of vehicle ownership. 19 Similarly, residence in redlined areas is associated with worse breast cancer outcomes. 20 More recently, the COVID-19 pandemic further widened this gap, due to safety concerns associated with public transportation use and lower access to telehealth among certain racial and ethnic groups. 21 , 22

To improve understanding of barriers to accessing health care, we sought to identify sociodemographic factors associated with public vs private transportation as well as longer distance and time traveled for health care visits. We hypothesized that compared with non-Hispanic White respondents, non-Hispanic Black respondents are more likely to use public transportation and experience longer travel time to seek medical care, with the largest disparities observed among those with lower household incomes.

We conducted a cross-sectional study using the US Department of Transportation’s 2017 National Household Travel Survey (NHTS). 23 Since the survey uses deidentified data, we obtained a human participants exemption from review and informed consent from the Mass General Brigham institutional review board. The study was carried in accordance with relevant guidelines and regulations with the Declaration of Helsinki. Informed consent to participate in the survey was obtained by the US Department of Transportation. This nationally representative data set serves as the primary source of information on daily travel behavior and modes of transportation. 23 The data were analyzed between June and August 2022. This study adheres to the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline for observational studies.

The NHTS was conducted from March to May 2017 among a stratified random address-based sampling of households across 50 states. 23 The sampling frame was derived from the US Postal Service Computerized Delivery Sequence File, and addresses were assigned to 1 of the following 4 sampling strata: addresses located in Metropolitan Statistical Areas (MSAs) with access to heavy rail transit and more than 1 million people, MSAs with 1 million people but without access to heavy rail transit, MSAs with fewer than 1 million people, and non-MSAs. A sample of addresses were selected at 2 different periods throughout the recruitment process to ensure the sampling is nationally representative.

The first phase of the study involved the household recruitment survey, while the second phase of the study was a person-level survey. The primary mode of household recruitment involved a mail-back survey with phone or web responses as secondary options. The collection of person-level information was conducted via phone or web. The 2017 NHTS includes households that completed the household recruitment survey and retrieval survey for all members aged 5 years and older. Of 252 304 recruited households, the final data set included information from 129 696 households, 264 234 respondents, and 923 572 trips over a year. The weighted recruitment response rate, which accounts for base weights representing the probability of selection for each sampled address, was 30.4% The weighted survey retrieval rate was 51.4%. The overall response rate, the product of the recruitment and retrieval response rates, was 15.6%. Weighted response rates were used to account for regional sampling biases. To aid data collection, households completing the recruitment interview were provided with personalized travel logs to record their travel on the assigned day. Informants recorded a 24-hour travel diary for days assigned randomly throughout the week between April 19, 2016, and April 25, 2017. A respondent recruitment flowchart is included in eFigure in Supplement 1 .

The survey data were weighted over 12 months, generating annual national estimates. Weights were adjusted for household-level nonresponse by accounting for characteristics that were known to be associated with response propensity. 24 Iterative proportional fitting was used to ensure that the final weights sum to known benchmark controls from the American Community Survey adjusting for nonresponse and population undercoverage, including geography and race and ethnicity. 24

The survey included households with noninstitutionalized civilians with at least 1 adult household member. Trips for household members who were aged 5 years and older were included. We restricted the sample to trips for health care visits (medical, dental, and therapy). The type of health care visit was not recorded in the NHTS.

Our primary comparison was the use of public transportation vs private vehicle. Public transportation was defined as the use of 1 of the following modes of transportation: public or commuter bus, intercity or commuter rail, and subway, elevated, light rail, or streetcar. Private transportation was defined as the use of 1 of the following modes of transportation: car, SUV, van, and pickup truck. We excluded trips made with taxis and rideshares because they constituted only 0.73% of all health care trips.

Respondents used online mapping software (Google Maps; Alphabet) to map their trip origin and destination and for each trip specified the trip purpose, mode of transportation, and time of the day. To estimate the burden of travel experienced for health care visits, we used the respondent-reported trip duration and the calculated shortest path distance generated by the mapping software’s application programming interface, based on mapped trip origin and trip distance.

We categorized covariates into person-, trip-, and community-level correlates selected based on prior literature. 6 , 25 We also examined self-reported race and ethnicity and annual household income quartiles as modifiers of associations between public transportation use and travel burden.

Self-reported race and ethnicity were categorized into Hispanic, non-Hispanic Black, non-Hispanic White, and other (including American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and respondents with multiple races.). Additional person-level covariates included sex, age (<26, 26-50, 51-75, and ≥76 years), highest educational attainment (≤high school graduate; some college, associate degree, or bachelor’s degree; and graduate degree or professional degree), and household annual income quartiles (<$25 000, $25 000-$49 999, $50 000-$999 999, and ≥$100 000). Trip-level covariates included the use of public transport, trip on business days (Monday through Friday), and trip during business hours (between 8:00 am and 4:59 pm ). Community-level covariates included household urban area classification based on the 2014 TIGER/Line Shapefile (urban, urbanized area or urban cluster, and rural), US Census region (Northeast, Midwest, South, and West), household located in an area with heavy metropolitan rail or subway, and proportion of renter-occupied housing in the census tract of the household’s location.

We used the trip as the unit of analysis. We weighed our sample using household identification number (ID) as the primary sampling unit to estimate outcomes and mean travel burden at the national level. We computed the median and IQR for the survey-weighted trip duration (minutes) and distance (miles) and compared them across covariates using Somers D test, an alternative to the Wilcoxon test for analyzing complex survey data.

To identify whether there are racial differences in public transportation use for health care visits, we fit a multivariable survey-weighted logistic regression adjusting for the respondent, trip, and community characteristics and clustered by household ID. Then, to assess factors associated with travel burden, we fit multivariable survey-weighted linear regression models separately for trip duration and distance. Models were adjusted for the respondent, trip, and community characteristics and clustered by household ID.

We performed subgroup analyses for trips that originated from urban vs rural settings. We presented results from models to estimate public transportation use in the overall population and urban only, due to few rural public transport users. Since socioeconomic status is associated with public transportation use, 26 we divided our cohort by household annual income quartile. We assessed whether there was an interaction of race and ethnicity with public transportation use for trip time and distance in each income quartile. We conducted survey-weighted multivariable linear regression models, clustered by household ID, with a multiplicative interaction term for race and ethnicity and public transportation use. These models estimated the incremental change in mean trip time and distance for each race and ethnicity category when using public transportation compared with private vehicles. We repeated this analysis within each household income quartile.

All analyses were performed using Stata statistical software version 17 (StataCorp). P values were 2-sided, and P  < .05 was considered significant.

The sample included 12 092 households and 15 063 respondents who had trips for medical care, of whom 1028 respondents (6.9%) were Hispanic, 1164 respondents (7.8%) were non-Hispanic Black, and 11 957 respondents (79.7%) . Most respondents were female (8930 respondents [59.3%]), and 8500 respondents (56.4%) were aged 51 to 75 years. We captured 16 760 health care visit trips or a weighted annual national estimate of 5 550 527 364 trips, of which 15.0% (95%CI, 12.9%-17.3%) were taken by Hispanic individuals, 13.9% (95% CI, 11.8%-16.3%) were taken by non-Hispanic Black individuals, and 64.0% (95CI, 61.1%-66.8%) were taken by non-Hispanic White individuals. Most health care trips were made using a private vehicle (94.0% [95% CI, 93.3%-95.5%]) and originated in urban settings (81.1% [95% CI, 78.9%-83.2%]). Other respondent, trip, and community characteristics are depicted in Table 1 .

Non-Hispanic Black respondents traveled shorter distances compared with non-Hispanic White respondents (median [IQR], 4.3 [1.6-9.8] miles vs 5.8 [2.3-12.7] miles; P  = .01) but had similar median travel times (median [IQR] duration, 22.0 [13.0 to 40.0] minutes vs 20.0 [10.0 to 30.0] minutes; P  = .07). Respondents with a household income less than $25 000 had longer trip durations than respondents with a household income of $100 000 or more (median [IQR] duration, 25.0 [15.0 to 39.0] minutes vs 15.0 [10.0 to 30.0] minutes; P  < .001) but traveled similar distances. Although trips using public transport were shorter in distance (median [IQR] distance, 3.9 [2.1 to 7.6] miles vs 5.9 [2.5 to 12.9] miles; P  < .001), they were more than twice as long in duration compared with trips in private vehicles (median [IQR] duration, 50.0 [28.0 to 75.0] minutes vs 20.0 [10.0 to 30.0] minutes; P  < .001). The median trip times and distances by respondent, trip, and community characteristics are illustrated in Table 1 .

Among the entire cohort, non-Hispanic Black respondents had increased odds of using public transportation for health care visits compared with non-Hispanic White respondents (odds ratio [OR], 3.54 [95% CI, 1.90 to 6.61]; P  < .001) ( Table 2 ). Additionally, compared with respondents with household income of $100 000 or greater, respondents with household income less than $25 000 were more likely to use public transportation (OR, 7.16 [95% CI, 3.50 to 14.68]; P  < .001).

Respondents with no access to railway (OR, 0.21 [95% CI, 0.12 to 0.74]; P  < .001) and respondents residing in rural settings (OR, 0.07 [95% CI, 0.03 to 0.19]; P  < .001) reported lower odds of public transportation use; while respondents residing in areas with more than 55% of renter-occupied households had higher odds of public transportation use (OR, 10.76 [95% CI, 5.20 to 22.25]; P  < .001). Additionally, respondents residing in the South, Midwest, and West census regions were less likely than those in the Northeast to use public transportation for health visit trips ( Table 2 ). We also found similar results among respondents residing in urban settings ( Table 2 ).

Table 3 depicts the factors associated with longer trip duration and Table 4 depicts the factors associated with longer trip distance. Longer trip duration was observed among non-Hispanic Black respondents compared with White respondents in urban settings (mean difference, 4.8 [95% CI, 0.01 to 9.5] minutes), but not in rural settings ( Table 3 ). No differences in trip distance were observed by race and ethnicity ( Table 3 ). Despite traveling a similar median distance, respondents with a household income less than $25 000 spent a mean difference of 5.1 (95% CI, 1.8 to 8.3) minutes longer than respondents with a household income of $100 000 or more. Respondents with household income less than $25 000, compared with respondents with household income of $100 000 or more, in rural settings traveled longer distances (mean difference, 6.2 [95% CI, 0.8 to 11.6] miles) and for longer durations (mean difference, 13.8 [95% CI, 5.9 to 22.3] minutes).

Respondents in rural settings had longer trip duration (mean difference, 11.1 [95% CI, 7.4 to 14.7] minutes) and distance (mean difference, 8.2 [95% CI, 5.9 to 10.5] minutes). Respondents residing in the West and South census regions had longer trip distance than those residing in the Northeast but reported no difference in trip duration relative to other census regions ( Table 4 ). Respondents residing in communities with higher renter-occupied households reported shorter trip durations and distances ( Table 3 and Table 4 ).

The incremental change in travel burden associated with public transportation relative to private vehicle use varied more by race for trip duration than travel distance ( Table 5 ). Non-Hispanic Black respondents had longer trip durations using public transport vs private vehicle in the $25 000 to $49 999 household income category (mean difference, 81.9 [95% CI, 48.5 to 115.3] minutes), compared with non-Hispanic White respondents (mean difference, 25.5 [95% CI, 17.5 to 33.5] minutes; P for interaction < .001). Hispanic respondents using public transport had longer trip duration (mean difference, 23.9 [95% CI, 13.2 to 34.6] minutes) but shorter distances (mean difference, −5.8 [95% CI, −9.7 to −2.0] miles) compared with private vehicle use in the $25 000 to $49 999 household income category ( P for interaction < .001). A subgroup analysis among trips taken from urban settings showed similar results (eTable in Supplement 1 ).

This cross-sectional study used a nationally representative survey of households in the US to examine the respondent-, trip-, and community-level factors associated with public transportation use and travel burden for health care visits. We found that non-Hispanic Black respondents and respondents with lower socioeconomic status were more likely to use public transportation than non-Hispanic White respondents with higher income. We observed variations in the additional travel time between public and private transportation based on race and ethnicity and household income. Specifically, in the second income quartile, the additional trip duration associated with public transportation was significantly higher among non-Hispanic Black respondents compared with non-Hispanic White respondents. However, within the lowest and highest income groups, racial disparities in travel burden were mitigated, resulting in comparable travel time for health care visits. These findings are especially relevant in urban settings. Our findings indicate that certain racial and ethnic groups among lower income populations are more likely to use public transportation, which incurs a higher travel burden when seeking medical care.

Based on the findings of a study by Probst et al 25 that uses the 2001 NHTS survey, we can compare trends in racial and ethnic patterns of travel burden when seeking health care in 2001 vs 2017. There was a decline in public transportation use from 2.7% in 2001 to 2.2% in 2017. 25 A study by Wolfe et al 6 using data from the National Health Interview Survey found that the reporting of transportation barriers had increased from 1997 to 2017. 6 Taken together, these studies suggest that although its use has declined over the past 16 years, public transportation remains an important means for socially disadvantaged populations to access health care.

We further examined how public transportation was associated with travel burden across racial and ethnic and income strata. We found that travel burden using public transportation vs private vehicle use was greater among Hispanic and non-Hispanic Black respondents than non-Hispanic White respondents among those with and income of $25 000 to $49 999 and $50 000 to $99 999, but not among those with the lowest and highest income categories. This suggests that the influence of public transportation on travel burden varied based on both race and ethnicity and income, with the difference being more pronounced among certain income groups. Minoritized populations are more likely to live in neighborhoods that are poorly served by public transportation and far from high-quality health care services, 11 consequences of racial segregation arising from discriminatory housing poalicies. 27 Additionally, car ownership is associated with significant financial burden, especially with increasing gas prices and substantial parking fees at treatment centers. 28 For example, patients with cancer require more frequent health care visits, so physical barriers to care can have a direct association with their receipt, continuity, and quality of treatment and care. 29 , 30 These data suggest that interventions to augment or strengthen existing public transportation along routes from underserved areas to health care facilities could serve as an equity-oriented approach to increasing health care access. Nevertheless, since rural settings have less or no public transportation access and are inherently less densely populated, high costs of public transportation infrastructure in rural settings may require alternative strategies to address racial and ethnic disparities in affordable transportation to health care. 31 Our findings, along with earlier studies demonstrating that socioeconomically disadvantaged populations made greater use of public transportation and experienced greater physical barriers to accessing health services, provide evidence for policy makers and transportation planners. Transportation barriers experienced by disadvantaged populations could be addressed by subsidizing costs and improving convenience of travel to and from medical facilities. Examples of potential interventions include vouchers, ridesharing services, or increasing access to telehealth among minoritized and economically disadvantaged populations. 32 , 33 Ridesharing services have been proposed because they can be scheduled as needed, use direct routes, are readily available in most urban areas, and cost less. 34 - 36 However, evidence suggests that ridesharing services might only reduce missed appointment rates among populations with specific transportation needs 37 or among those requiring multiple visits for cancer treatment completion. 38 Furthermore, successful implementation of these interventions would necessitate appropriate funding, infrastructure, and coordination.

This study has some limitations. This is a cross-sectional survey relying on a sample of participants who agreed to provide data; therefore, findings may not be generalizable to all communities. However, this is a large, nationally representative survey in the US, providing variability in race and ethnicity, socioeconomic status, and geographic coverage. Second, the survey collects participant-reported travel times and a web-based mapping service calculated shortest network path distance, which may not reflect the exact route taken by respondents, potentially underestimating disparities in travel burden. 23 Third, the survey does not capture individuals who do not have access to health care because of other barriers, such as insurance coverage. Moreover, the type of health care visit is not reported; thus, we could not distinguish between the reason of visit or whether respondents had several visits per year. Although we have examined multilevel factors associated with longer commute duration, qualitative studies could further help in understanding the transportation barriers minoritized populations face.

This cross-sectional study found that minoritized populations and respondents with lower socioeconomic status were more likely to rely on public transportation than other groups, contributing to a higher travel burden in accessing care. Strengthening or augmenting existing transportation routes targeting underserved populations could reduce racial disparities in access to care and downstream health outcomes.

Accepted for Publication: June 12, 2023.

Published: July 27, 2023. doi:10.1001/jamanetworkopen.2023.25291

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2023 Labban M et al. JAMA Network Open .

Corresponding Author: Quoc-Dien Trinh, MD, MBA, Brigham and Women’s Hospital, Division of Urological Surgery, Harvard Medical School, 45 Francis St, ASB II-3, Boston, MA 02115 ( [email protected] ).

Author Contributions: Drs Labban and Trinh had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Labban, Lipsitz, Reich, Rebbeck, Choueiri, Kibel, Iyer, Trinh.

Acquisition, analysis, or interpretation of data: Labban, Chen, Frego, Nguyen, Lipsitz, Iyer, Trinh.

Drafting of the manuscript: Labban, Chen, Frego, Nguyen, Lipsitz.

Critical revision of the manuscript for important intellectual content: Frego, Nguyen, Lipsitz, Reich, Rebbeck, Choueiri, Kibel, Iyer, Trinh.

Statistical analysis: Labban, Chen, Lipsitz, Iyer.

Obtained funding: Choueiri.

Administrative, technical, or material support: Chen, Kibel.

Supervision: Frego, Reich, Choueiri, Kibel, Trinh.

Conflict of Interest Disclosures: Dr Choueiri reported receiving personal fees from Alkermes, AstraZeneca, Aravive, Aveo, Bayer, Bristol Myers-Squibb, Calithera, Circle Pharma, Eisai, EMD Serono, Exelixis, GlaxoSmithKline, Gilead, IQVA, Infinity, Ipsen, Jansen, Kanaph, Lilly, Merck, Nikang, Nuscan, Novartis, Oncohost, Pfizer, Roche, Sanofi/Aventis, Scholar Rock, Surface Oncology, Takeda, Tempest, Up-To-Date, Peerview, OncLive, and MJH Life Sciences; having patents filed on molecular alterations and immunotherapy response and toxiceffects, and ctDNA; owning stock in Tempest, Pionyr, Osel, Precede Bio, and CureResponse; serving on committees for the National Comprehensive Cancer Network, Genitourinary Steering Committee of the American Society of Clinical Oncology/European Society for Medical Oncology, Academic and Community Cancer Research United, and KidneyCan; and salary support from the Dana-Farber–Harvard Cancer Center Kidney SPORE, Kohlberg Chair at Harvard Medical School, and the Trust Family, Michael Brigham, Pan Mass Challenge, Hinda and Arthur Marcus Fund, and Loker Pinard Funds for Kidney Cancer Research at Dana-Farber Cancer Institute outside the submitted work. Dr Trinh reported receiving personal fees from Astellas, Bayer, and Janssen and grants from Pfizer outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported by the Department of Defense Prostate Cancer Research Program Health Disparity Research Award (award No. PC220551).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

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• Published: 20 September 2022

Transportation barriers to care among frequent health care users during the COVID pandemic

• Abigail L. Cochran   ORCID: orcid.org/0000-0002-7866-4865 1 , 2 ,
• Noreen C. McDonald   ORCID: orcid.org/0000-0002-4854-7035 1 ,
• Lauren Prunkl   ORCID: orcid.org/0000-0001-8136-4874 1 , 3 ,
• Emma Vinella-Brusher   ORCID: orcid.org/0000-0001-6416-6892 1 ,
• Jueyu Wang   ORCID: orcid.org/0000-0003-1568-0195 1 , 4 ,
• Lindsay Oluyede   ORCID: orcid.org/0000-0002-1039-8409 1 , 5 &
• Mary Wolfe   ORCID: orcid.org/0000-0001-6043-1433 6  

BMC Public Health volume  22 , Article number:  1783 ( 2022 ) Cite this article

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Transportation problems are known barriers to health care and can result in late arrivals and delayed or missed care. Groups already prone to greater social and economic disadvantage, including low-income individuals and people with chronic conditions, encounter more transportation barriers and experience greater negative health care consequences. Addressing transportation barriers is important not only for mitigating adverse health care outcomes among patients, but also for avoiding additional costs to the health care system. In this study, we investigate transportation barriers to accessing health care services during the COVID-19 pandemic among high-frequency health care users.

A web-based survey was administered to North Carolina residents aged 18 and older in the UNC Health system who were enrolled in Medicaid or Medicare and had at least six outpatient medical appointments in the past year. 323 complete responses were analyzed to investigate the prevalence of reporting transportation barriers that resulted in having arrived late to, delayed, or missed care, as well as relationships between demographic and other independent variables and transportation barriers. Qualitative analyses were performed on text response data to explain transportation barriers.

Approximately 1 in 3 respondents experienced transportation barriers to health care between June 2020 and June 2021. Multivariate logistic regressions indicate individuals aged 18–64, people with disabilities, and people without a household vehicle were significantly more likely to encounter transportation barriers. Costs of traveling for medical appointments and a lack of driver or car availability emerged as major transportation barriers; however, respondents explained that barriers were often complex, involving circumstantial problems related to one’s ability to access and pay for transportation as well as to personal health.

Conclusions

To address transportation barriers, we recommend more coordination between transportation and health professionals and the implementation of programs that expand access to and improve patient awareness of health care mobility services. We also recommend transportation and health entities direct resources to address transportation barriers equitably, as barriers disproportionately burden younger adults under age 65 enrolled in public insurance programs.

Peer Review reports

Transportation barriers create obstacles to health care and are known to result in delayed and missed appointments as well as medication use [ 1 ]. 5.8 million people in the United States delayed medical care in 2017 because they did not have transportation [ 2 ]. Groups that are already prone to greater social and economic disadvantage, including individuals who are poor and/or under or uninsured and who have chronic conditions, are more likely to encounter transportation barriers to care and experience negative health consequences [ 2 , 3 , 4 , 5 ]. Addressing transportation barriers that result in delayed or missed care is important not only for mitigating adverse health care outcomes among patients, but also for avoiding additional costs to the health care system stemming from increased use of emergency departments and hospitalizations [ 6 , 7 , 8 , 9 ].

The COVID-19 pandemic widely disrupted health and transportation systems in the US. Beginning in March 2020, many health systems deferred non-emergency medical procedures and other elective care [ 10 ]. The postponement of medical care remained high throughout 2020. Giannouchos et al. found that 26.9% of adults 18–64 reported having foregone medical care from August to December 2020, while 35.9% reported having delayed care [ 11 ]. Though in-person appointments have resumed, many fields face unprecedented patient care backlogs [ 12 ]. Public transportation systems reduced service in many cases during the early months of the pandemic response, and riders reported hesitation using public or shared modes due to concerns about infection risk [ 13 ]. This likely exacerbated transportation barriers to health care for people without access to a personal vehicle, including some individuals with disabilities [ 14 ].

Using mobile device data to explore temporal patterns in visits to health care points of interest during 2020, Wang et al. found census block groups in North Carolina with higher population density and those with higher percentages of older adults, low-income individuals, racial and ethnic minorities, and people without household vehicles had lower rates of medical visits during the pandemic and experienced a slower recovery in visits after the state’s most restrictive lockdown period spanning from mid-March to May 2020 [ 15 ]. This may indicate that problems accessing transportation and other barriers to health care are disproportionately affecting populations already known to experience transportation and health disadvantages, particularly during the pandemic.

Synthesizing knowledge on transportation access to health care during the pandemic, Chen et al. found that some patients seeking care required additional support, particularly those who already experienced socioeconomic and transportation disadvantages such as low-income individuals, people of color, and people with disabilities [ 10 ]. They were not always able to rely on others or on public transportation for rides like they had in the past, experienced added challenges because of economic hardship due to COVID-19, and found it more difficult to fulfill their health care needs using telemedicine. The authors suggested that partnerships between health and transportation systems hold promise for addressing transportation barriers during and after the pandemic but noted that these partnerships, i.e., arrangements to provide non-emergency medical transportation (NEMT) services, are largely limited to low-income patients enrolled in Medicaid. They reviewed alternative strategies for addressing patients’ transportation needs, including new models for providing NEMT though health care partnerships with ridehailing companies (e.g., Uber and Lyft) as well as innovations in health care coordination and policy, and concluded that such strategies might reduce transportation barriers and promote equity in health care access.

In this study, drawing on results of a survey conducted with high-frequency health care users in North Carolina, we investigate transportation barriers to accessing health care during the COVID-19 pandemic. We examine if and how adult North Carolina residents in the UNC Health Care (“UNC Health”) system who had at least six outpatient medical appointments between April 2020 and April 2021 and are enrolled in Medicaid or Medicare encountered transportation barriers. We explain how barriers affected respondents’ care due to having delayed, missed, or arrived more than 20 minutes late to appointments because of transportation problems. Using demographic and other information collected for respondents, we analyze what factors were associated with reporting transportation barriers that resulted in negative care outcomes. We conclude by making recommendations regarding strategies to address transportation barriers that might meet the needs of high-frequency health care users who have greater health care-related transportation burdens and are more likely to encounter transportation barriers to care.

Sampling and recruitment

The goal of this research was to examine transportation-related barriers to accessing health care among groups known to have greater health care and health care-related transportation burdens, including low-income people, older adults, and individuals with chronic conditions. We thus purposively sampled from these groups, i.e., people with low incomes and those aged 65 and older, and individuals that needed to access care multiple times during the previous year. We recruited participants using data provided by the Carolina Data Warehouse for Health (CDW-H), a central data repository containing clinical, research, and administrative data sourced from the UNC Health system. UNC Health is a not-for-profit medical system owned by the state of North Carolina; while based in Chapel Hill, UNC Health operates hospitals and medical practices across the state. At the recruitment stage we selected from 34,387 individuals to generate a sample of ~ 15,000 people who met the following inclusion criteria: (1) have Medicaid or Medicare as their primary insurance; (2) are North Carolina residents; (3) are over age 18; (4) have a valid email address; and (5) had six or more outpatient visits between April 2020 and April 2021.

Our first inclusion criterion, having Medicaid or Medicare as one’s primary insurance, predictably skewed our sample toward people aged 65 and older. To achieve greater representation of adults aged 18–64, we oversampled from this age group. We then quota-sampled amongst older adults so that the recruitment sample of individuals aged 65–79 and over 80 approximately matched the population of North Carolina; 15.9% of the state population is aged 65–79 and 4.5% is 80 plus according to recent Census estimates [ 16 ]. A total of 14,723 people were ultimately included in the recruitment sample, comprising 6945 individuals aged 18–64; 6201 individuals aged 65–79; and 1577 individuals aged 80 or older (Table  1 , column 1).

Data collection

The research study protocol, including all data collection instruments, was reviewed and approved by the Institutional Review Board at the University of North Carolina at Chapel Hill. Data were collected using REDCap, a secure web platform for managing online databases and surveys. We sent an email invitation to participate in our web-based survey and up to three reminders. The recruitment emails announced that respondents would be entered into a drawing to receive one of twenty $50 gift cards. Respondents completed an eligibility screener to confirm they met the inclusion criteria, a consent form, and an optional HIPAA authorization. Survey data collection occurred between June 21 and July 23, 2021. Upon completion of data collection, 728 individuals completed the eligibility screener and 433 completed the consent form. 383 individuals at least partially completed the survey questionnaire, representing a 2.6% response rate.

Study sample

323 eligible respondents who answered all questions analyzed in this study were included in the study sample (Table 1 , column 2). Like the recruitment sample, the study sample included greater representation of adults aged 65–79 (52.9%) than other age groups; 38.7% of respondents were aged 18–64 and 8.4% were aged 80 years or older. Similarly, as with the recruitment sample, a majority of respondents (57.9%) identified their gender as female. A greater percentage of individuals in the study sample identified their race or ethnicity as White or Caucasian (82.7%) and a smaller percentage as Black or African American (13.0%) compared to the recruitment sample. The racial breakdown of the recruitment sample more accurately reflects state-level estimates indicating 71.6% of North Carolina residents aged 18 and older identify as White or Caucasian and 21.9% identify as Black or African American [ 17 ].

Data analysis

Analytic approaches.

We generated descriptive statistics to investigate the prevalence of reporting transportation “difficulties” or “problems”, which we collectively refer to as “barriers,” that resulted in having arrived late to, delayed, or missed care. We quantified these barriers and health care outcomes based on respondents’ individual and household characteristics and reported the unadjusted association using Fisher’s exact test. We then conducted multivariate binomial logistic regressions to better understand the adjusted associations of individual, household, and geographic characteristics with transportation barriers that resulted in negative health care outcomes.

Independent variables

We collected information on individual and household-level variables known to influence travel behavior and people’s experiences using transportation and health care. Of particular interest to this study, we asked respondents to report how many times they went in person to medical appointments or treatments in the past year. Appointment frequency affects the likelihood of late arrivals and has been shown in previous studies to be associated with missed appointments [ 18 ]. We collected demographic information on respondents’ age, gender, race, and ethnicity. For statistical tests and regression analyses, we grouped respondents into two age bins: 18–64 years and 65 years or older. We also combined race/ethnicity categories to report race as White or Non-White; respondents who described themselves as “White” (regardless of whether they also identified as another race or as Hispanic, Latino, or Spanish) were included in White and those who did not describe themselves as “White” were included in Non-White. Respondents were asked to report whether they had a “disability or chronic condition that limits your daily activities”; those who replied “Yes” to this question were considered to have a disability in our analyses. We also asked respondents to identify what type(s) of health insurance they had.

Respondents were further asked to share their home ZIP code as well as to report how many motor vehicles are available for use by people in their household. In our analyses, household vehicles were classified as “None” for those who reported zero vehicles available for use in their household and “One or more” for those who reported at least one vehicle was available. We used data provided by CDW-H on the location of UNC Health clinics (including UNC Physicians Network doctor’s offices) to calculate the number of medical clinics in respondents’ home ZIP codes.

Outcome measures

We utilized four binary outcome measures to indicate how transportation barriers impacted healthcare usage and access. Respondents reported on whether transportation problems resulted in one of several health care outcomes of interest occurring in the past year: (1) delaying the scheduling of a medical appointment or treatment, (2) missing a medical appointment or treatment, (3) arriving more than 20 minutes late to a medical appointment or treatment, or (4) experiencing any of these three concerns. Delayed care and missed appointments have been linked with numerous negative consequences for patients, including increased hospitalizations, additional visits to emergency departments, and poorer long-term health outcomes [ 7 , 9 , 19 ]; late patient arrivals may have consequences such as disrupted clinic service operations and decreased overall service quality for patients [ 20 ].

• Transportation barriers

Using data from questions asking respondents to elaborate on “transportation problems” that caused them to arrive late to, delay, or miss care, we identified commonly-reported transportation barriers. We further investigated and characterized these barriers by analyzing answers to open-ended text response questions. We used a thematic analysis approach [ 21 ] to code these responses in Dedoose, a web-based application for analyzing qualitative and mixed methods research with text data. The use of such qualitative techniques in travel behavior studies has been effective for adding depth and richness to findings on the subjective experiences of individuals related to using transportation [ 22 ].

Prevalence of transportation barriers to health care

Among our study sample, 35.3% ( N  = 114) and 18.3% ( N  = 59) of respondents reported having delayed or missed medical appointments or treatments in the past year, respectively, because of transportation barriers; 16.4% ( N  = 53) of respondents reported having arrived more than 20 minutes late to a medical appointment or treatment in the past year because of transportation problems; and 39.0% ( N  = 126) experienced at least one of these outcomes (Table  2 ). Prevalence of transport barriers varied significantly with demographic, household, and spatial characteristics (Table 2 ). Individuals 65 and older, males, people without disabilities, and individuals with household vehicle access reported lower rates of transport barriers across the four measures. Individuals with no medical clinics in their home ZIP code were more likely to report being late and delaying or missing care. Individuals with higher numbers of medical appointments were also more likely to report being late due to transport barriers.

Regression analysis of the relationship between demographics and transportation barriers

In a series of binomial regression analyses, we further tested the association between individual, household, and geographic characteristics and transportation barriers resulting in negative care outcomes. Looking at our adjusted models in Table  3 , we found the likelihood of having arrived late to, delayed, or missed a medical appointment or treatment in the past year because of transportation barriers was significantly higher for younger adults aged 18–64 compared to older adults aged 65 and over. Not having a disability was associated with lower odds of having arrived late to or delayed care as well as the combined outcome. Having household vehicle(s) was similarly significantly associated with a reduced probability of having delayed or missed care. The number of medical clinics in the home ZIP, the number of appointments in the past year, gender, and race were not significantly associated with the probability of limiting care due to transport barriers.

Explaining transportation barriers

15.2% ( N  = 49) of respondents reported that the cost of traveling prevented them from going to a medical appointment, while 20.7% ( N  = 67) reported that not having a ride posed a barrier to seeking or reaching care. When asked to elaborate on which costs contributed to transportation barriers, respondents mentioned the costs of gasoline; parking; fares for public transportation, taxis, and app-based ridehailing services like Uber and Lyft; paying a friend to drive them or reimbursing someone for gasoline or car use; tolls; and buying meals and lodging while traveling for care. One respondent wrote, considering the cost calculus of getting to a medical appointment at the hospital, “It costs 3/4 tank of fuel, $28, to do a round trip to the hospital plus $12 for parking. If I don’t schedule my appointments the right way, sometimes money is very tight when my monthly check is running out before I get the next one.” Another respondent similarly explained that transportation costs could become prohibitive considering other finances, writing, “Taxi fares are expensive. ... I’m on a fixed income and don’t have but 100 [dollars] left after rent and utilities to pay for [my] medication copay and transportation.”

Respondents who reported not having a ride posed a barrier to getting care explained that they did not have a ride for a number of reasons related to driver availability, or not having access to someone who could drive them at the time of their appointments or treatments; car availability, contingent on whether a car they had access to was working or whether they typically had access to a vehicle at all; the availability of alternative transportation services, including public or community transportation; and scheduling issues associated with using demand response transportation services (e.g., dial-a-ride, paratransit). Respondents also mentioned that traffic, construction or unexpected delays, and inclement weather contributed to not having a ride to a medical appointment because their driver did not show up or to arriving late to scheduled appointments.

Often, respondents reported that a combination of barriers kept them from reaching care—some related to transportation costs and driver or car availability and others related to their state of health. In this way barriers were complicated by conditional access to transportation as well as changes in people’s ability to travel for care. One respondent explained they could not get to a recent appointment because, “We have one vehicle. My partner could not get off from work to take me [to the appointment]. If a car had been available, I do not feel very comfortable driving myself with the medications I take.” Another recounted a recent trip to a doctor’s appointment in which weather, driver availability, and their health all contributed to difficulties: “It started raining and I could not find a driver. I tried to drive but had a vertigo spell so ended up pulling over.” Fortunately, they wrote, after pulling over, “I called the office. My provider was able to talk to me on the phone and my husband rescued me later in the day.” While this instance may not have substantially interrupted this respondent’s care, it highlights the complex, compounding, circumstantial difficulties that can contribute to transportation barriers.

Approximately 1 in 3 respondents in our study sample reported having experienced transportation barriers between June 2020 and June 2021 that resulted in having arrived late to, delayed, or missed a medical appointment or treatment. This is notably higher than previous studies have found for similar health care user populations. Wolfe et al. found that of US adults aged 19 plus who self-reported having a “poor” health status and who had made 4 or more emergency department visits in the past year, 11.6% and 11.9% had delayed care due to lack of transportation [ 2 ]. We expect that our sample of high-frequency health care users has both greater health care needs and health care-related transportation burdens, likely exacerbated by the COVID-19 pandemic. It is problematic, then, that transportation barriers affected a substantial number of respondents. Costs of traveling for medical appointments and a lack of driver or car availability emerged in our study as major transportation barriers to health care. However, respondents explained that transportation barriers were often complex, involving circumstantial problems related to one’s ability to access and pay for transportation as well as their personal health, which, in some cases, compromised people’s ability to travel in a particular way (i.e., as a driver) or entirely.

Transportation barriers were experienced unequally. Results indicate that younger adults aged 18–64, people without vehicle access, and people with disabilities were significantly more likely to encounter transportation barriers resulting in having arrived late to, delayed, or missed medical appointments or treatments regardless of how many appointments they had.

All respondents in our sample were enrolled in Medicaid or Medicare. While most respondents were aged 65 and older and had Medicare ( N  = 204), a subset were adults aged 18–64 enrolled in Medicaid ( N  = 73), Medicare ( N  = 92), or dual-enrolled in both public insurance programs ( N  = 35). Consistent with previous research, we found these respondents—younger adults enrolled in Medicaid or Medicare—were more likely to encounter transportation barriers to health care [ 2 , 5 ]; this may be because they have low incomes and may experience other socioeconomic and transportation disadvantages. As high-frequency health care users enrolled in public health insurance programs, these respondents also likely experience more health-related disadvantages—for instance, they may have disabilities or chronic conditions, or may generally be in poorer health—that keep them from accessing reliable transportation and consistent care. In our study, of the 135 respondents aged 18–64, 88.1% ( N  = 119) had a disability.

These findings are interesting given Medicaid members and adults with disabilities enrolled in Medicare should qualify for the NEMT benefit and be eligible to use paratransit, respectively; both NEMT and paratransit services are intended to reduce transportation barriers. Our findings suggest high-frequency health care users aged 18–64, who were more likely to report encountering transportation barriers, may not be aware of these services or otherwise may not use them. It is possible that the circumstantial, potentially transient nature of transportation barriers may contribute to more barriers resulting in negative health care outcomes. For example, individuals who sometimes have access to a household vehicle or driver may not think to seek alternatives or plan back-up transportation for when they do not have a car or driver available. Similarly, an individual who can usually drive themselves to medical appointments or treatments may not be aware of alternative arrangements for when they cannot due to illness or injury. Even if they are aware of alternatives, such as NEMT or transit/paratransit offerings, these services must typically be scheduled in advance.

Our findings must be considered in the context of the COVID-19 pandemic, which exacerbated transportation barriers, particularly those resulting in delayed care, in part by reducing transportation and health care availability. Chen et al. detailed ways in which the pandemic has affected transportation access to health care and found that people generally needed extra help with trips to care; furthermore, people with elevated health risks as well as low-income individuals and people of color have been disproportionately burdened by transportation barriers [ 10 ]. Our findings support these conclusions and provide more evidence that the pandemic is likely exacerbating transportation and health disparities that disadvantage people that may need to seek care more, such as those with disabilities and chronic conditions, as well as those who use public insurance programs.

Though our study sample is not statistically representative, findings from this research shed light on transportation barriers that may be generalizable, particularly to other high-frequency health care users enrolled in Medicaid or Medicare. As we found that younger adults enrolled in public health insurance programs and individuals with disabilities in our sample were more likely to encounter transportation barriers, it is likely that the findings of our study underestimate the prevalence of transportation barriers; people with low incomes, disabilities, and those in very poor health are often underrepresented in survey studies and may not have access to the technology required to complete a web-based questionnaire [ 23 , 24 , 25 ]. Furthermore, rural residents are known to encounter more transportation barriers and have less internet access [ 26 ], and were underrepresented in our study sample; only 12.4% of respondents ( N  = 40) lived in non-metropolitan areas. More investigation is needed of transportation barriers affecting individuals likely to experience compounding transportation and health disadvantages, including individuals enrolled in Medicaid, younger adults with disabilities enrolled in Medicare, and people living in rural areas.

Conclusions and recommendations

We offer recommendations that might address the complex transportation barriers that affect high-frequency health care users and disproportionately burden younger adults aged 18–64 enrolled in public health insurance programs. First, echoing Chen et al., we recommend more coordination between transportation and health professionals and the implementation of programs to expand and improve patient awareness of medical transportation programs, including the NEMT benefit, paratransit services, and others [ 10 ]. Ensuring patients have the information they need to access care is particularly important during this time of health crisis. Communicating health and medical transportation information to those who need it should be prioritized at points of care (e.g., doctor’s offices, hospital-based outpatient clinics, dialysis centers, etc.) and through established transportation and medical communications channels such as transportation reservation lines and patient listservs [ 14 ]. Medical providers could also make this information available during telehealth appointments and using patient engagement platforms like patient portals and mobile applications, which patients may have become more familiar with during the pandemic.

Second, we recommend that transportation and health entities address major transportation barriers, including transportation costs and availability. This might be done by providing subsidies for expenses such as gasoline and parking, which respondents in our study indicated could be prohibitive to seeking health care. These would likely be best coordinated between transportation and medical stakeholders, including health insurance plans, medical providers, and transportation providers. To improve medical transportation availability, we recommend that transportation and health care entities explore adopting emerging technologies and participating in innovative collaborations to provide or expand health care mobility services. Wolfe and McDonald identified three popular approaches for this, including health care providers leveraging app-based ridehailing technology to book patient trips; health plans partnering with ridehailing companies to expand transportation offerings to beneficiaries; and transit/paratransit providers partnering with ridehailing companies to offer more flexible services [ 27 ]. Resources might also be directed to improve existing transit services or planned public transportation projects to facilitate access to medical clinics [ 28 ]. Health care providers should also consider solutions that link disadvantaged households to health services by “decentralizing care,” or building up health service infrastructure in local institutions so that they can serve people in surrounding neighborhoods [ 29 ]. Creating satellite or mobile clinics that can run out of local pharmacies, housing complexes, and schools, for example, is a way to disperse health resources, reduce transportation burdens associated with seeking care, and generally expand access to care, particularly in underserved communities.

Third, we recommend that transportation and health entities direct resources to address transportation barriers equitably, as our findings concord with those of other studies showing transportation barriers and negative health care outcomes are not experienced evenly. Our results suggest that more attention should be given to alleviating transportation barriers among adults aged 18–64 enrolled in public health insurance programs and individuals with disabilities. Members of these groups may already qualify for targeted transportation assistance programs such as NEMT and paratransit, but they may not be aware of them. These and other transportation programs also may not be accessible to those who need them; for instance, people with certain disabilities may require wheelchair-accessible vehicle services and individuals without access to internet-enabled devices may need to schedule transportation by phone. Policies and programs to address transportation barriers to care must be designed with accessibility and equity as guiding tenets to serve individuals seeking care most effectively and ultimately promote transportation and health care access.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available to protect respondents’ privacy; de-identified data may be available from the corresponding author on reasonable request.

Abbreviations

Carolina Data Warehouse for Health

• Non-emergency medical transportation

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Acknowledgements

Authors are grateful to all study respondents for sharing their time and valuable insights. We also thank three anonymous reviewers of this article for their helpful comments.

This work was supported by the US Department of Transportation through the Southeastern Transportation Research, Innovation, Development, and Education (STRIDE) Center. This funding body had no role in study design; data collection, analysis, and interpretation; nor in the writing of the manuscript.

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AC led design of the study, created data collection instruments, oversaw data collection, led data interpretation/analysis, and prepared the original draft of the manuscript. NM led funding acquisition for the study, contributed to the study design, provided supervision for all research activity, and contributed to reviewing and editing the manuscript. LP, EVB, and JW contributed to data interpretation/analysis and reviewing and editing the manuscript. LO contributed to reviewing and editing the manuscript. MW contributed to early stages of the study design as well as to reviewing and editing the manuscript. All authors read and approved the final manuscript.

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Cochran, A.L., McDonald, N.C., Prunkl, L. et al. Transportation barriers to care among frequent health care users during the COVID pandemic. BMC Public Health 22 , 1783 (2022). https://doi.org/10.1186/s12889-022-14149-x

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Healthcare in Russia

This guide was written prior to Russia's 2022 invasion of Ukraine and is therefore not reflective of the current situation. Travel to Russia is currently not advisable due to the area's volatile political situation.

The standard of healthcare in Russia is not of a level that most expats would be accustomed to. That said, the quality varies from hospital to hospital, with some facilities offering a good level of care. 

Wherever possible, expats should try to utilise private healthcare in Russia. Private facilities can be exorbitantly expensive, and expats will likely need to organise some form of private health insurance that includes emergency evacuation to elsewhere in Europe. While this might not be necessary for those living in the major cities, some rural parts of Russia have minimal healthcare available. 

Public healthcare in Russia

Though once heralded as one of the best healthcare systems in the world and known for world-class medical innovations, public healthcare in Russia today is underfunded and falls well below the standards expected by most expats. Generally, facilities are not of the highest standard, supplies can be scarce, and waiting times are almost always long.

Many of the health professionals in the public system don’t speak English, which can be an issue for expats. Treatment in the public sector is supposed to be free of charge for all Russian citizens and foreigners with permanent residency, but there have been reports in the past of doctors withholding treatment unless they receive a bribe.

Private healthcare in Russia

In Russia’s larger cities there are a number of private health centres and clinics, many of which have English-speaking staff. These facilities are generally of a much higher standard than their public counterparts but are also comparably more expensive. Hospitals may ask for cash or credit card payments before providing treatment.

It is vital that expats have adequate health insurance to cover the hefty fees. This can be organised through their employer or independently. Expats should ensure that their insurance covers the specific facility which they would most likely visit, as many policies will only cover certain hospitals and clinics.

No strong relationship exists between price and quality of private healthcare in Russia. The most expensive clinic may not be the best, and it’s advisable to source recommendations from other expats or reputable forums. Expats living in rural Russia will struggle to find internationally recognised private facilities, and may need to travel to the nearest city to receive reliable treatment. 

Health insurance in Russia

Russian citizens and permanent residents are entitled to free public healthcare under the Russian national healthcare system. Employers and employees finance the fund, contributing a small percentage of their salary to a social tax which then goes into the national healthcare fund.

Healthcare at public facilities in Russia is well below what many expats may be used to, and it’s essential that expats arrange private health insurance before moving to Russia. Many expats choose to travel outside of Russia for serious medical care, and it is important for expats to ensure that any health insurance policy makes provisions for this. 

Medicines and pharmacies in Russia

There is a good assortment of pharmacies in Russia. Some of these operate out of larger supermarkets, while some exist as standalone stores and others are available online as ePharmacies. Larger cities like Moscow have some 24-hour pharmacies as well as pharmacies with delivery services.

Expats should be sure to learn the generic name of their preferred medications, as brand names may vary from country to country.

Emergency services in Russia

State ambulance services are available in major Russian cities, although services are often limited. Emergency numbers have been consolidated into a single emergency service which can be reached by dialling 112. A number of private ambulance services are also in operation in Russia.

Further reading

►For more on healthcare in the capital, including a list of hospitals in the city, see  Healthcare in Moscow .

Expat Experiences "As my city is located outside of Moscow, it is quite small compared to the capital. It only has a few hospitals. Some are free if you have OMS, the main insurance in Russia if you are a temporary or permanent resident or a citizen. Some you must pay for. I prefer to go to the paid one as I’ve heard lots of bad feedback about the free ones." Read more about Eva, an expat from Indonesia, her move to Russia and any tips she has about expat life in the city. 

Are you an expat living in Russia?

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DESTINATION

1. Overview

Brief introduction to the country and its reputation in medical tourism.

Russia, the world’s largest country by land area, offers a unique blend of history, culture, and cutting-edge technology. While Russia may not be the first destination that comes to mind when considering medical tourism, it has been gaining traction in this field. With substantial investments in healthcare infrastructure and medical research, Russia is slowly but steadily becoming a destination worth considering for various medical procedures. The country has a growing reputation for offering state-of-the-art medical treatments, often at a fraction of the cost you might pay in Western Europe or North America.

Historical and Cultural Significance in Medicine

Russia has a long-standing history of medical research and innovation. From the times of renowned scientists like Ivan Pavlov to contemporary achievements in cardiology and neurology, the country has been instrumental in contributing to global medical science. Russian medical institutions have also been engaged in pioneering work in fields like radiology, organ transplantation, and aerospace medicine, reflecting a cultural emphasis on scientific inquiry and innovation.

The Medical Landscape

The Russian healthcare system is a mix of public and private institutions, providing an array of treatments ranging from general medicine to specialized surgeries. While public healthcare is generally available to citizens, the growing private healthcare sector caters to both local and international patients, often providing services that match global standards.

What Draws Medical Tourists to Russia?

Medical tourists often find Russia appealing due to its advanced technology, specialized treatments, and relatively lower costs. Moreover, the prospect of combining medical treatment with a cultural experience is another attractive feature. Known for its grand architecture, vibrant arts scene, and rich history, Russia offers an all-around travel experience alongside high-quality medical care.

2. Popular Medical Procedures

List and brief descriptions of procedures.

• Cosmetic Surgery : Including procedures like rhinoplasty, liposuction, and breast augmentation, Russia is increasingly becoming a destination for cosmetic surgery.
• Dental Treatments : Dental implants, crowns, and veneers are some of the sought-after treatments.
• Cardiac Surgery : With advanced technology, cardiac procedures like bypass surgeries and angioplasties are performed at specialized centers.
• Orthopedic Surgeries : Hip and knee replacements are commonly done here with a high success rate.

Specializations or Pioneering Treatments

Russia is becoming known for its cancer treatments, including specialized radiation therapies and immunotherapy treatments. Additionally, the country has been involved in research and treatment of neurological conditions, offering specialized services in this domain.

3. Top Hospitals & Clinics

Renowned hospitals and clinics.

• Almazov National Medical Research Centre, St. Petersburg
• European Medical Center, Moscow
• Moscow City Clinical Hospital

Accreditation and Affiliation

Most top hospitals are accredited by Russian healthcare authorities and some even possess international accreditations. These hospitals often collaborate with international medical institutions for research and training purposes.

Special Features, Awards, or Recognitions

Many hospitals have received awards for medical excellence and innovations in treatments. They also offer features like English-speaking staff, modern facilities, and state-of-the-art medical equipment.

4. Cost Comparison

Comparative data.

On average, medical procedures in Russia can cost 30-70% less than in Western Europe or North America. For instance, a dental implant that might cost upwards of $3,000 in the United States could be available for around $1,000 in Russia.

Price Ranges

Costs can vary based on the facility, location, and type of procedure. Always get multiple quotes and consult with healthcare providers to get a more accurate picture.

5. Quality & Safety

Medical standards and practices.

Russia is committed to ensuring high standards of medical care, supported by its educational system that produces skilled doctors and medical professionals. While there might be variations in quality between rural and urban centers, most metropolitan areas have hospitals and clinics equipped with modern technology and well-trained staff.

Accreditation Systems and Regulatory Bodies

In Russia, medical facilities are generally regulated by the Ministry of Health. While not all hospitals may have international accreditations, most top institutions meet or exceed global healthcare standards.

Quality Checks and Patient Safety Protocols

Russian healthcare providers employ a variety of safety measures such as pre-surgical consultations, sterilization protocols, and rigorous post-operative care. They also tend to follow internationally recognized best practices to ensure patient safety.

Patient Rights

Patients have the right to quality healthcare, the right to choose their physician, and the right to confidentiality. These are enshrined in Russian medical law and are generally adhered to by healthcare providers.

6. Medical Visa Information

Guidelines and requirements.

To obtain a medical visa, you generally need a formal invitation from the Russian medical institution where you plan to receive treatment. Proof of financial stability and medical insurance are often required.

Duration, Documentation, and Application Process

The visa can be valid for up to 90 days, with possible extensions in case of medical necessity. Documentation usually includes your passport, invitation letter, visa application form, and photographs. Applications are typically processed within 10 to 20 business days, although expedited services are available for an additional fee.

Travel-related Advisories or Restrictions

It’s advisable to keep an eye on travel advisories and consult your home country's embassy or consulate for the most current information.

7. Cultural Considerations

Local customs and etiquette.

While Russia is generally welcoming to tourists, being aware of local customs and etiquette can enrich your experience. A basic understanding of Russian manners, such as greetings and proper attire, can be beneficial.

Language and Communication

While the primary language is Russian, English is often spoken in large hospitals and medical centers. Nonetheless, it's advisable to confirm the availability of English-speaking staff or interpreters.

Dietary Considerations

Russia offers a variety of cuisine options, though traditional foods might be heavy in meat and dairy. Vegetarian and vegan options are increasingly available, particularly in larger cities.

8. Travel & Accommodation

Popular areas to stay.

Moscow and St. Petersburg are popular destinations with proximity to top medical facilities. Both cities offer a range of lodging options, from luxury hotels to budget-friendly hostels.

Proximity to Medical Facilities

Medical centers are often well-connected by public transportation or are just a short drive away from popular accommodation areas.

Transportation and Infrastructure

Russia has an extensive public transportation network, including subways, buses, and taxis. Apps like Uber are also widely used.

Post-procedure Relaxation and Recuperation Spots

Russia is rich in natural beauty, from the beaches of Sochi to the serene landscapes of Siberia, offering plenty of options for post-procedure relaxation.

9. Legal & Ethical Considerations

Legal rights of patients.

Patients have the right to informed consent, confidentiality, and quality healthcare as per Russian laws.

Medical Malpractice Laws and Patient Recourse

In cases of medical malpractice, patients have the right to legal recourse. However, legal proceedings can be long and complex.

Ethical Considerations

Ethical standards are generally in line with international norms. Issues such as organ transplantation are strictly regulated.

10. Benefits & Risks

Among the benefits are lower costs, high-quality specialized treatments, and the opportunity to explore Russian culture and history.

Potential Risks

Language barriers and variations in quality between rural and urban healthcare centers are some of the risks involved. Always conduct thorough research and consultations before proceeding with any medical treatment.

11. Post-procedure Care

Post-operative care.

Russian medical facilities often offer robust post-operative care programs, including rehabilitation and follow-up appointments.

Availability and Quality of Rehabilitation Centers

Rehabilitation centers, especially in metropolitan areas, are well-equipped and staffed with trained medical professionals.

12. Frequently Asked Questions (FAQs)

• Is English widely spoken in Russian hospitals? In major cities and top healthcare centers, yes. However, it's advisable to confirm this before you travel.
• How do I pay for medical procedures? Payment methods vary, but most top hospitals accept credit cards and wire transfers.
• Is it safe to travel alone? While generally safe, it is always advisable to be cautious and aware of your surroundings, especially in unfamiliar areas.
• Is medical insurance necessary? Yes, proof of medical insurance is usually a requirement for obtaining a medical visa.
• What is the quality of post-procedure care? High-quality post-procedure care is often available, particularly in specialized medical centers.

Global Provider Members

Russian Ruble

144,500,000

With an area the size of Russia, it is difficult to give any sort of general advice about the climate and weather, except that summers are warm to hot, and winters get very cold in some areas. In general, the climate of Russia can be described as highly continental, with warm-to-hot, dry summers and (very) cold winters with temperatures of -30°C or lower. Heavy snowfall is not uncommon.

Facilitators

Featured treatments.

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