With housecalls largely a thing of the past, when it comes to using health care services, the first thing we have to do is get ourselves to the provider. That’s not a problem for most of us with cars or access to public transportation, but for many others, getting to the doctor can be quite challenging. There are cases where people absolutely lack transportation, which is an enormous barrier to receiving care. Added to that are those whose financial resources are such that the cost of transportation must be taken into consideration. In some cases, decisions must be made that go something like, “I can take the subway down to the clinic, but it’s going to cost me $6 roundtrip. I was gonna use that money to buy lunch today. Do I really feel bad enough to go to the doctor? Maybe I should just wait and see how I feel in a day or two.”
A recent paper by Richard Nelson and colleagues, which appears in the Journal of Rural Health, takes a look at what happened to veterans’ use of VA health care services when a policy change led to an increase in the amount they are reimbursed for travel. The increase was 17.5 cents per mile (from 11 up to 28.5), and it had the effect of increasing the odds of having any outpatient visit by 6.8% and increased the number of visits by 2.6%. These increases were statistically significant. The bottom line: Paying more of a person’s travel costs reduces the transportation barrier and leads to better health care access and more utilization.
It’s also important to note that inpatient utilization was not affected by the increased reimbursement rates. I take that to mean that once a person is sick enough to be admitted, they’re going to get themselves to the hospital somehow–probably via ambulance. It’s earlier on, when the person isn’t gravely ill, that they remain price-sensitive and may decide to go without care. That leads to the possibility that they end up getting sicker.
Now, consider this dynamic in the reverse. As gas prices increase, the cost of transporting oneself to the doctor also increases. For price-sensitive individuals and conditions, this may well begin to represent a barrier to care. Rising gas prices, it appears, have the potential to make us decide we really don’t need to go to the doctor that badly. Depending on how much of that forgone care is medically necessary, the high price of gas might actually be making us sicker. Something to think about at your next fill-up.