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Abstract
This research examines the many ways that public transportation affects health, with a focus on rural and small urban areas. First, a comprehensive literature review is conducted. Research on the social determinants of health, access to health care, physical activity benefits, social isolation, and mental health and how each is related to public transportation are reviewed. The study examines transportation to health care services in rural and small urban areas, the role of public transportation in improving access to care, and the effects of missed or delayed health care trips. A survey was conducted of older adults in non-metro areas across the United States that asked questions related to health care use and travel behavior, as well as impacts from the COVID-19 pandemic on access to care. Regression analyses of the survey data and data from the Medical Expenditure Panel Survey (MEPS) were conducted to understand factors related to delayed health care as well as the impact of delayed care on total health care expenditures. Analysis of the survey data showed that those without access to a vehicle and those who reported difficulties using transit since the pandemic started were significantly more likely to have missed a health care trip. Analysis of the MEPS data showed that missed health care trips were more likely as travel time to health care services increased, and health care expenditures were significantly higher for those who had missed or delayed a health care trip.
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