Access to Transportation and Health Care Visits for Medicaid Enrollees With Diabetes

J Rural Health. 2018 Mar;34(2):162-172. doi: 10.1111/jrh.12239. Epub 2017 Mar 28.


Purpose: Diabetes is a chronic condition that requires frequent health care visits for its management. Individuals without nonemergency medical transportation often miss appointments and do not receive optimal care. This study aims to evaluate the association between Medicaid-provided nonemergency medical transportation and diabetes care visits.

Methods: A retrospective analysis was conducted of demographic and claims data obtained from the Oklahoma Medicaid program. Participants consisted of Medicaid enrollees with diabetes who made at least 1 visit for diabetes care in a year. The sample was predominantly female and white, with an average age of 46.38 years. Two zero-truncated Poisson regression models were estimated to assess the independent effect of transportation use on number of diabetes care visits.

Findings: Use of nonemergency medical transportation is a significant predictor of diabetes care visits. Zero-truncated Poisson regression coefficients showed a positive association between the use of transportation and number of visits (0.6563, P < .001). Age, gender, race/ethnicity, area of residence, and presence of additional chronic conditions had independent associations with number of visits. Older enrollees were likely to make more visits than younger enrollees with diabetes (0.02382); controlling for all other factors in the model, rural residents made more visits than urban; women made fewer visits than men (-0.09312; P < .001); and minorities made fewer visits than whites, with pronounced differences for Hispanics and Asians compared to whites.

Conclusions: Findings underscore the importance of ensuring transportation to Medicaid populations with diabetes, particularly in the rural areas where the prevalence of diabetes and complications are higher and the availability of medical resources lower than in the urban areas.

Keywords: Medicaid; access to medical care; access to transportation; diabetes; health care visit.

MeSH terms

  • Adult
  • Continental Population Groups / statistics & numerical data
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / therapy*
  • Female
  • Health Services Accessibility / standards*
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Male
  • Medicaid / organization & administration
  • Medicaid / statistics & numerical data*
  • Middle Aged
  • Oklahoma / epidemiology
  • Poisson Distribution
  • Retrospective Studies
  • Rural Population / statistics & numerical data
  • Transportation / standards*
  • Transportation / statistics & numerical data
  • United States