Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.

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Traveling Towards Disease: Transportation Barriers to Health Care Access

Exposing some important barriers to health care access in the rural USA

Background
Many studies have examined barriers to health care utilization, with the majority conducted in the context of specific populations and diseases. Less research has focused on why people avoid seeking medical care, even when they suspect they should go.

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Why do People Avoid Medical Care? A Qualitative Study Using National Data

Understanding shortages of sufficient health care in rural areas

Background
Distance to healthcare services is a known barrier to access. However, the degree to which distance is a barrier is not well described. Distance may impact different patients in different ways and be mediated by the context of medical need.

Distance is Relative: Unpacking a Principal Barrier in Rural Healthcare

Context: Many rural elders experience limited access to health care. The majority of what we know about this issue has been based upon quantitative studies, yet qualitative studies might offer additional insight into individual perceptions of health care access. Purpose: To examine what barriers rural elders report when accessing needed health care, including how they cope with the high cost of prescription medication. Methods: During Spring 2001, thirteen 90-minute focus groups were conducted in 6 rural West Virginia communities. A total of 101 participants, aged 60 years and older, were asked several culminating questions about their perceptions of health care access. Findings: Five categories of barriers to health care emerged from the discussions: transportation difficulties, limited health care supply, lack of quality health care, social isolation, and financial constraints. In addition, 6 diverse coping strategies for dealing with the cost of prescription medication were discussed. They included: reducing dosage or doing without, limiting other expenses, relying on family assistance, supplementing with alternative medicine, shopping around for cheapest prices, and using the Veteran's Administration. Conclusions: Overall, rural older adults encounter various barriers to accessing needed health care. Qualitative methodology allows rural elders to have a voice to expound on their experiences. Research can contribute valuable information to shape policy by providing a forum where older adults can express their concerns about the current health care delivery system.

Perceived Barriers to Health Care Access Among Rural Older Adults: A Qualitative Study

Employer benefits from making workplace accommodations

Cost of workplace accommodations for individuals with disabilities: with or without personal assistance services.

In the United States people with disabilities represent the nation's largest minority and a considerable, largely untapped pool of labor. According to the 2006 American Community Survey data, a disability prevalence rate among adults of ages 21 to 64 years was 12.9% (Cornell University StatsRRTC, 2007; Wells, 2008). In 2006, the employment rate of all people with disabilities continued to be below 38% (Cornell University StatsRRTC; Hernandez & McDonald, 2007). In 2005, there were approximately 21.5 million working-age people with disabilities in the U.S. Of those, about 13.3 million were not employed and 8.2 million were employed. Of those 8.2 million working-age people with disabilities who were employed, only approximately 1.8 million were working full-time (Lengnick-Hall, Gaunt, & Kulkarni, 2008). If the U.S. aims at increasing its future labor supply, the nation should devote effort to mobilize people with disabilities to join the competitive job market (Ozawa & Yeo, 2006; Pelkowski, 2007). In American culture, work is a socially esteemed activity for any person with or without a disability. To be an important part of an integrated employment setting, many people with disabilities need support services (Wehman, 2003). One resource for such support is the Job Accommodation Network (JAN). JAN provides a nationwide service for all entities interested in employment of people with disabilities. JAN consultants offer expert guidance to employers, service providers, persons with disabilities, and others who make possible the employment and retention of workers with disabilities (http://www.jan.wvu.edu). Proper job accommodations (e.g., ergonomic equipment modifications, adaptive and assistive technology, special lighting, flexible schedule, sign-language interpreters, personal assistants, and job coaches) are indispensable for maximizing the employment among individuals with disabilities (Williams, Sabata, & Zolna, 2006). One of the forms of accommodation for people with disabilities who need help with activities of daily living (ADLs) such as eating, dressing, grooming, and instrumental activities of daily living (IADLs) such as shopping, house cleaning, paying bills, or using telephone is Personal Assistance Services (PAS) (Benjamin, 2001). Personal assistance is effective in helping people with disabilities in their ADLs and IADLs (Meng et al., 2006). In the U.S., the term "personal assistance" came from the disability community to refer to day-by-day help for people with self-care limitations (Kitchener & Caro, 2007). In a broader sense, PAS may include all help, "whether hands-on, standby, or supervisory, whether paid or unpaid" (LaPlante, Kaye, Kang, & Harrington, 2004, p. S98). The concept of PAS has expanded to include both community-based assistance and workplace assistance. Currently, the call for for PAS is rapidly growing in comparison to the U.S. labor supply (Batavia, 2001; Hagglund, Clark, Farmer, & Sherman, 2004; Hagglund, Clark, Mokelke, & Stout, 2004; Hewitt & Larson, 2007; Kitchener, Ng, Carrillo, Miller, & Harrington, 2007; Stout, Hagglund, & Clark, 2008). According to Kaye, Chapman, Newcomer, and Harrington (2006), the number of people in the U.S. who would need PAS will rise from 13 million in 2000 to 27 million in 2050. These authors cite the aging American baby-boomers who will require assistance as the primary factor to account for this increase. In addition, people with disabilities are taking advantage of the availability of Medicaid programs for home health and personal assistance services as a means of staying in their homes and out of residential care. Legislative mandates, such as the Olmstead Act, also will result in an increased number of people who receive services in non-institutional settings. These factors will likely impact the need for PAS. PAS, as a contemporary formal employment accommodation, is a fairly new concept in the U. …

Tatiana I. Solovieva

Papers

Perceived Barriers to Health Care Access Among Rural Older Adults: A Qualitative Study

Employer benefits from making workplace accommodations

Cost of workplace accommodations for individuals with disabilities: with or without personal assistance services.

Workplace Personal Assistance Services for People with Disabilities: Making Productive Employment Possible

Personal assistance services in the workplace: A literature review