Healthcare Access Begins with the First Mile

For patients, healthcare doesn’t begin in a waiting room—it begins the moment they decide to seek care.

But for too many people, that first step is also the hardest one to take.

Every year, millions of patients delay or skip appointments because they can’t get there. In the U.S. alone, an estimated 5.8 million people miss or postpone medical care due to transportation barriers, according to the American Hospital Association. These aren’t isolated incidents—they’re systemic, preventable failures in how we think about access.

For case managers, social workers, and clinical leaders tasked with improving outcomes, transportation may not always be top of mind. But the data—and the human stories—say otherwise.

Transportation Is a Health Equity Issue.

From rural towns to dense urban centers, the challenges look different, but the impact is the same: missed care, delayed treatment, and worse outcomes.

• Rural patients may live hours from the nearest provider and lack reliable or affordable transit.
  
  
• Urban patients may live closer to care, but still face significant hurdles: unsafe public transportation, financial insecurity, physical disabilities, or caregiving responsibilities that complicate travel.
  
  
• Older adults and people with chronic conditions may depend on others for rides—or go without care when support falls through.

According to a study published in JAMA Internal Medicine, adults who experience transportation insecurity are twice as likely to report poor health, and significantly more likely to delay care or go without needed prescriptions.

This isn’t just a matter of convenience. It’s a critical determinant of health—one that intersects with race, income, geography, and disability status. And it affects your no-show rates, your readmissions, and your ability to meet quality benchmarks.

We’ve Conditioned Patients to “Tough It Out.”

In many communities, there’s a cultural script that says, “Don’t go unless it’s really bad.” It’s how patients protect themselves from the burden of navigating an inaccessible system.

We see this in rural farming communities where patients delay care until a crisis. In urban neighborhoods where missing work—or finding childcare—feels more daunting than the illness itself. We also see family caregivers who downplay their own exhaustion to keep everything afloat.

The consequence? Lower utilization of preventive services. Increased reliance on emergency departments. Higher downstream costs for systems already stretched thin.

Utilization Isn’t the Problem. Inaccessibility Is.

The past few years have complicated how we talk about healthcare utilization. During the early days of COVID-19, postponing care was framed as a public good. But long after the pandemic’s peak, millions of Americans are still forgoing basic, preventive, or chronic care—not because they choose to, but because they don’t see another option.

It’s time to reframe the narrative. Appropriate, timely care is not over-utilization. It’s exactly what we should be encouraging.

But if patients can’t physically get to where care happens, the rest of our efforts fall short.

A Shared Responsibility

When a patient misses a dialysis session or skips a follow-up appointment, it can be tempting to frame it as a personal failure—or even just an operational nuisance. But in many cases, it's neither.

It’s a systemic failure. And it's a call to action for those of us who design and deliver care.

As case managers and health system leaders, you’re often the bridge between clinical goals and real-life barriers. That makes you uniquely positioned to rethink how transportation fits into your care model—especially for patients with chronic needs, social vulnerabilities, or complex care plans.

What Better Could Look Like.

Better transportation doesn’t mean luxury vans or massive infrastructure investments. It can be as simple as:

• Scheduling non-emergency rides in coordination with care plans.
  
  
• Empowering caregivers and social workers to book or arrange transportation.
  
  
• Offering flexible, same-day options for urgent appointments.
  
  
• Partnering with transportation providers that understand the nuances of healthcare (HIPAA compliance, accessible vehicles, etc.).
  
  
• Treating transportation as part of the care continuum, not an afterthought.

It’s also an opportunity to address disparities. Transportation interventions can be low-cost, high-impact levers for closing gaps in access, especially for Medicaid members, dually-eligible individuals, older adults, and patients facing housing or food insecurity.

The First Step Is Ours to Take.

If we want patients to show up, follow through, and feel empowered in their care journey, we need to make sure the journey itself is possible.

This isn’t just about solving for logistics. It’s about designing for dignity.

Let’s build a system where getting to care isn’t the hardest part.