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During a year when COVID-19 illness and prevention dominated conversations about health care, the pandemic also made it more difficult for many Americans to go to the doctor for non-COVID-19 care. In June 2020, more than one in three Americans reported that they had delayed or not received necessary medical care within the past month because of the pandemic. By late March 2021, that figure had improved only slightly, to nearly one in four. The reasons for this delayed or missed care are many, but transportation is one of them.
During the pandemic, trips to the doctor’s office, like all travel, became more complicated. Stay-at-home orders, cuts to public transit service, and suspension of some shared-ride programs — not to mention concerns about contracting or spreading COVID-19 — deprived people of their usual ways of moving around. Even when people could travel for health care, many found they had no place to go. Many community clinics temporarily reduced their hours and canceled most in-person visits and non-emergency procedures. Moreover, many people who lost their jobs also lost their health insurance or had to switch to lower-cost plans that covered fewer services at fewer locations.
Although it’s difficult to assign transportation a precise share of the blame for the pandemic’s disruption of medical care, it is clear that transportation played a role. As we emerge from a year of isolation and uncertainty, we have reason to fear that COVID-19’s impact on transportation has widened health disparities that existed well before the pandemic began.
Black, Latinx, and low-income communities have long contended with higher rates of chronic health conditions that require in-person care — such as heart failure, end-stage kidney disease, and prostate or cervical cancer — as well as greater difficulty reaching that care. One study estimated that Black and Latinx patients, compared to white patients, were about twice as likely to have delayed seeking health care specifically because of transportation problems. A big part of the problem is that driving, whether to the doctor’s office or anywhere else, is often a privilege of the healthy. In general, the most medically vulnerable patients not only seek health care more often, but also — because of their worse health and lower socioeconomic position — more often rely on public transit, rides from others, or programs like paratransit and Medicaid’s Non-Emergency Medical Transportation service, or NEMT, to access that frequent care. Patients with end-stage kidney disease, for example, typically take three to four round trips each week to undergo hemodialysis, a life-sustaining process that filters their blood to remove toxins and excess fluids. About three-quarters of these patients rely on transportation programs or rides from others to get to dialysis.
The COVID-19 pandemic has likely made it even harder for these disadvantaged groups to get health care when they need it. A CDC report from June 2020 found that Black and Latinx adults were 33% and 53% more likely than white adults to have delayed or avoided any medical care due to concerns about COVID-19. Differences in car access may, again, explain at least part of this disparity.
Low-income people and people of color are more likely to rely on modes of travel — such as public transit and carpooling — that make social distancing difficult, and that (in the case of transit) have seen service reduced during the pandemic. In these situations, seeking medical care is more likely to involve tough decisions about whether the benefit of the visit is worth the risk of the trip.
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