Providing transportation for low-income patients that reduces no-show rates for doctor visits by just 25% could lower public costs more than $15,000 per month as well as extend a lifeline for critical health care.
“It has been established that high no-show rates of publicly supported health systems in economically depressed areas are largely due to a lack of inexpensive, reliable transportation,” wrote researchers from The University of Texas Health Science Center at San Antonio, also known as UT Health San Antonio, and from The University of Texas at Austin.
They set out to determine the financial feasibility of offering transportation and investigate net cost savings by reducing no-show rates. Their findings of a significant cost savings are published by The Operational Research Society, in a paper titled, “Offering transportation services to economically disadvantaged patients at a family health center: a case study.”
The facility in this case is the Family Health Center in downtown San Antonio, a collaboration between University Health of the Bexar County Hospital District and physicians from the Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio. The publicly subsidized clinic provides care for the most vulnerable patient population in the city.
The Patient and Family Advisory Council that meets each month to advise the clinic started the conversation about transportation. Researchers analyzed data on 636 patients of the clinic and calculated the impact of various transportation factors on cancellations, no-shows and late-arrivals. They then determined cost savings of reducing the no-show rate, and weighed it against expenses should the center provide transportation.
The conclusion was that by reducing the no-show rate from 24.3% to 18.2%, or by about 25%, net public costs could be reduced by $15,167 to $22,746 a month – even providing a ride – in offset revenue loss to the clinic and avoided public emergency-room or hospital costs arising from missed clinic visits. That’s more than $182,000 per year that could be put to good use to help patients stay alive and well.
“This is critically important, because if a patient can’t afford or arrange for a ride to a doctor’s appointment, they could suffer or wind up needing emergency care, which can be extraordinarily expensive,” said Carlos Roberto Jaén, MD, PhD, FAAFP, chair of family and community medicine at UT Health San Antonio, and one of the study authors.
Other study authors include Ramin Poursani, MD, a clinical professor in family and community medicine at UT Health San Antonio; Jia Guo, PhD, and Jonathan F. Bard, DSc, graduate program in operations research and industrial engineering, Cockrell School of Engineering, The University of Texas at Austin; and Douglas J. Morrice, PhD, information, risk and operations management department, McCombs School of Business, The University of Texas at Austin.
“Missed appointments can lead to worsening symptoms and reduced quality of life, and then emergency services or even hospitalization,” Dr. Poursani said. “Lost revenue for the clinic threatens its ability to operate, and hospitalization of the uninsured is an enormous public expense.”
The study noted that the hospital inpatient cost per day is more than 141 times the cost of a non-emergency medical appointment, and the average length of a hospital stay is 6.85 days.
The researchers concluded that substantial reductions can be achieved by offering subsidized transportation to those patients who are the most financially and physically constrained. Those rides could include arrangements with public transportation, accounts with ride-hailing companies or taxi services, or other accommodations.
Offering transportation services to economically disadvantaged patients at a family health center: a case study
Jia Guo, Jonathan F. Bard, Douglas J. Morrice, Carlos R. Jaén and Ramin Poursani.
First published: July 25, 2021, The Operational Research Society