Cost-Benefit Analysis of Providing Non-Emergency Medical Transportation (2005) / Chapter Skim
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Chapter 4: Description of the TransportationDisadvantaged Population That Misses Medical Care Due to a Lack of Access to NonEmergency Medical Transportation In Chapter 3, the number of non-institutionalized people in the U.S. who are transportation disadvantaged and have missed non-emergency medical treatment at least once in the past 12 months was estimated to be approximately 3.6 million.
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4.2 Urban-Rural Split of the Target Population That Lacks Access to NEMT To determine the cost of providing the NEMT that this population needs, the target population of transportation-disadvantaged people that missed non-emergency medical care due to a lack of transportation must be disaggregated by location (urban and rural) , transportation service needs, and medical condition.
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Table 4-1: Number of Persons Missing NEMT Trips per Year in Urban and Rural Areas Age Category Urban Rural Adult 2,084,319 593,721 Children 785,233 136,727 Total 2,869,552 730,448 4.3 Identification of Medical Conditions Faced by Those Lacking NEMT In our analysis to identify the most important medical conditions for which lack of transportation is a barrier to health-care access, we focused on prevalent conditions for the transportation-disadvantaged population. We used the 2002 NHIS data to examine the prevalence of disease conditions and cross-tabulated this information with the NHIS concept of target population status, as described in Chapter 3.
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Condition Unweighted Frequency Percentage of Adults Sinusitis 101 16.9 Severe Sprains 99 20.0 Food/Odor Allergies 97 17.8 Diabetes 96 16.0 Irritable Bowel Syndrome 84 12.9 Menstrual Problems 73 13.1 Hay Fever 72 12.5 Thyroid Problems 71 11.7 Cancer 60 11.3 Gynecologic Problems 55 8.8 Stroke 44 8.1 Seizures 42 7.5 Menopausal Problems 40 6.5 Renal Disease 37 7.2 Hearing Aid 35 6.8 Liver Condition 35 6.7 Neuropathy 18 3.1 Multiple Sclerosis 6 1.2 Prostate 3 0.5 Parkinson's Disease 2 1.4 Psychological Problems: Hopeless 30 5.8 Nervous 45 8.5 Restless/Fidgety 41 8.8 Sad 28 5.2 Worthless 26 4.8 Before defining a list of conditions for further study, two comparisons between adults in the target population and all other adults, as seen in the NHIS data, are especially instructive: 1. Viewing the phenomenon of multiple diseases suffered by the same person: (1)
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Table 4-3: Prevalent Conditions in Adults from 2002 NHIS Condition Target population Prevalence (Percentage) Non-Target population Prevalence (Percentage)
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that we found for adults is also relevant. The results show a large difference both for the percentage experiencing multiple conditions from the list (32 percent for target population children versus 14 percent for non-target population children)
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Table 4-4 provides strong evidence that a comprehensive focus on children would include the following conditions: • ADHD/ADD and learning disabilities in general (as a way to avoid educational delays to the extent possible) • Asthma • Frequent headaches/migraines 4.3.3 Discussion and Conclusions from Analysis of Medical Conditions Our analysis of these nationally representative healthcare datasets reveals that about 3.6 million Americans miss or delay non-emergency medical care per year due to transportation difficulties.
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as it is for others. To the extent that visits are being delayed for these disadvantaged children, they could be subject to considerable pain and suffering that otherwise could be effectively treated.
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4.4 Utilization of Health Resources by the Target Population The prevalence of multiple health conditions (co-morbidities) has a demonstrable effect on the utilization of health resources.
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Table 4-8: Condition-Based Visits from the 2001 MEPS Condition # of Cases Average Visits Asthma 1,347 8.8 Heart Disease (CHF) 161 18.9 COPD 1,105 9.9 Hypertension 3,829 11.1 Diabetes 1,555 13.0 Depression 1,427 14.8 ESRD 34 115.0 4.4.1 Disease Prevalence and Co-Morbidities These results amplify a theme discussed in Chapter 2, that is, the target population (as represented in the NHIS)
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For each of the ten conditions, the disease prevalence is considerably higher for the target population -- transportation-disadvantaged persons who miss medical care due to a lack of access to NEMT -- compared to the remainder of the U.S. population.
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