Transportation is a fundamental necessity for accessing healthcare services. However, transportation barriers are a primary reason for appointment cancelations or delays, particularly in rural areas, adversely affecting individual health and increasing healthcare system costs. In this study, we conducted face-to-face interviews with individuals across rural areas in Illinois to investigate barriers they face when using non-emergency medical transportation (NEMT) to access healthcare facilities. We used thematic analysis to systematically organize themes by analyzing conversational notes in QSR NVivo software. The thematic analysis identified four key areas: (1) NEMT service provision, including service reliability, coverage, availability, the reservation system, and provider code of conduct; (2) travel experience, encompassing long journeys to healthcare centers, in-vehicle crowding, safety concerns, and travel costs; (3) transportation infrastructure; and (4) non-transportation issues. The results show that the unreliability of public transportation (both fixed-route and on-demand services) and NEMT significantly contributes to late arrivals and canceled medical appointments. Additionally, the closure of local hospitals during the COVID-19 pandemic has forced patients to travel longer distances for medical care, particularly affecting rural residents. Furthermore, a lack of awareness or understanding of insurance coverage for transportation costs results in out-of-pocket expenses, disproportionately affecting low-income individuals. These findings highlight the need for improved integration of transportation providers with the healthcare system, increased awareness of NEMT availability and insurance coverage, and modernization of reservation systems.
Yousefibaseri et al. (2025) studied this question.