Transportation barriers to health care: assessing the Texas Medicaid program
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Transportation is frequently cited as a barrier to health care, but rarely have researchers analyzed the problems in depth. The purpose of this study was to assess the role transportation plays in the utilization of preventive health care services among Medicaid recipients ages 0 - 20 in Texas. This preventive care is known as Early Periodic Screening and Diagnostic Testing (EPSDT), a comprehensive prevention and treatment program for Medicaid eligible children. Our computer assisted telephone interviewing based survey was administered to Medicaid recipients selected from a representative sample through a stratified sampling scheme. Binary logistic regression models were used to assess and predict factors associated with utilization of the Texas Medicaid Transportation Program (MTP) and utilization of EPSDT. We also used k-means cluster analysis to identify subgroups of Medicaid clients with particularly acute transportation barriers. Of the 1,214 Medicaid recipients interviewed, the overall odds of a Medicaid recipient being a MTP non-user was 0.94. For clients with automobile access, the probability increases to 0.98. Clients who experienced difficulties paying for gasoline decreased the overall odds to 0.86. When examining utilization of EPSDT, the overall probability of being a low utilizer was 0.59. Two factors, Spanish-speaking patients (0.21) and clients with more than one child at home (0.54) decreased the overall odds of being a low utilizer, while those with difficulty paying for gasoline increased the odds of being a low utilizer to 0.63. Increasing EPSDT utilization among the millions of Texas Medicaid recipients is an important policy objective. Because the Texas Medicaid population is large and diverse, no single approach to increasing utilization is likely to address all needs. The group concept provides a means to understand which Medicaid recipients do not access MTP services and those with low utilization rates. These groupings can be useful in targeting Medicaid clients with specific transportation difficulties. Instead of broad informational campaigns, policy makers should devise targeted strategies to promote the most appropriate types of assistance. In addition to expanding transportation options, policy makers should also examine the locations in which care is delivered, considering telemedicine, mobile health and school-based health clinics as options.
Borders, Stephen Boyce (2003). Transportation barriers to health care: assessing the Texas Medicaid program. Doctoral dissertation, Texas A&M University. Texas A&M University. Available electronically from