Transportation is a major barrier to medical care for many Americans. A lack of reliable vehicles or public transportation contributes to missed appointments, poorer outcomes, and lost revenue for health systems.
Seeing the need — and an opportunity — ride-hailing giants Uber and Lyft have made an ambitious entry into the healthcare sector. They promise healthcare providers a seamless, flexible, low-cost alternative to other non-emergency medical transportation options that are often unreliable, while also touting HIPAA-compliant interfaces.
Courtney Massaro, a certified nurse-midwife, sees the transportation struggle play out daily at Boston Medical Center’s Refugee Women’s Health Clinic. The clinic cares for refugees, asylum-seekers, and recent immigrants who face myriad obstacles to getting their needed healthcare. These challenges can include social issues as they acclimate to the Boston area, including securing food, housing, employment, and childcare in addition to transportation. One of Massaro's patients, who has a history of significant trauma, relies on her job at a big box store — working well beyond a typical retirement age — to send money to her children in her home country.
For Massaro and her colleagues, caring for one of the most marginalized populations has meant also confronting a clinic no-show rate that hovered close to 30%. Many women seeking the clinic’s services live outside of Boston in neighborhoods that do not directly link to public transit. With wait times and transfers for the bus or subway, the women seeking care at the clinic average a 71-minute one-way trip to the clinic. The entire journey to the clinic and back takes significant time away from the women' employment and family responsibilities.
To reduce the clinic’s no-show rate, the Refugee Women's Health Clinic’s staff launched a pilot study, published in the Journal of Immigrant and Minority Health, to provide Uber Health rides that could alleviate the transportation burden for qualifying patients.
"I might not be able to provide a babysitter or housing, but transportation is a fairly low-hanging fruit," says Massaro. "In this day and age, with the resources we have available, it is egregious if we are not able to help our patients get to the care that they need."
"In this day and age, with the resources we have available, it is egregious if we are not able to help our patients get to the care that they need"
– Courtney Massaro, Certified Nurse-Midwife
Any woman who voiced transportation difficulties in getting to their scheduled gynecological appointment was offered an Uber Health ride to and from that visit. Researchers scheduled the trips before the appointments using the Uber Health interface, and women received a text message when their ride arrived at their door. Women did not need the Uber app on their phone to receive a text message alert, and providers were able to track the status of their trips in real time.
"It was something we were obviously hopeful would be very impactful, but we were surprised by the ease at which our patients were able to navigate the system," says Massaro, noting that some of the women in her clinic are older, don’t speak or read English, or are from countries where cell phones and this sort of technology aren’t currently used.
With door-to-door service, the clinic's Uber Health intervention almost halved the travel time for these patients. Of the 31 clinic visits where women used Uber Health, only two missed their appointments, making no-shows among women who accepted rides just 6% compared to 30% among women who did not report transportation barriers and thus were not offered the service. The improved appointment adherence greatly impacted the clinic’s revenue — the eight-month pilot cost $2,033 in small grants and generated $30,337 in hospital charges.
Pilot programs such as these are being watched closely by providers and ride-hailing services alike. Although the potential of using ride-hailing services like Uber Health for medical transportation is evident, the feasibility and cost-effectiveness of the approach are still being tested and have produced mixed results. Some healthcare providers have experienced considerable success using the rideshare technology, but others' no-show rates haven't budged.
Massaro and her colleagues deemed the pilot enough of a success that the Refugee Women’s Health Clinic is continuing to offer Uber Health to women who require transportation assistance and hopes to expand it to more women that are not served under traditional non-emergency medical transport.
"The ride gave them one less thing to worry about," says Massaro.