of the NHTS could include additional questions on access to medical
care to further close the data gap. Other data sources can be used to
enhance the knowledge of diseases and comorbidities associated
with those experiencing transportation difficulties; however, only
these national data sets, appropriately modiﬁed, can provide reliable
estimates for national policy development.
For affected individuals, the consequences of missed health care
are more important than missing data. Consequences range from
quality-of-life concerns, such as the large proportion of transportation-
disadvantaged people who experience pain or aching joints, up
to life-threatening consequences, such as the importance of consis-
tent care for the high percentage of transportation-disadvantaged
children with asthma. An emerging perspective in the health arena
promotes evidence-based medicine and emphasizes that integrated
disease management has the potential to reduce health expenditures,
lower mortality, and increase quality of life (36). Transportation-
disadvantaged persons, however, are poor candidates for well-
managed care protocols that are based on frequent checkups to avoid
costly specialist care and unnecessary hospitalizations. Therefore, a
clear need is seen for cost-effectiveness analyses that investigate
transportation interventions to determine their effects on increas-
ing compliance with demanding care protocols for well-chosen
(i.e., amenable to successful treatment) conditions. Many conditions
faced by the roughly 3.6 million people that have been identiﬁed
(e.g., asthma, heart disease, and renal disease) can be managed if
appropriate care is made available. The authors have begun to use a
method to conduct these cost-effectiveness calculations. In essence,
it uses the literature to distinguish well and poorly managed care by
condition and then applies these designations to the MEPS expendi-
ture estimates. The difference in average expenditures between
poorly and well managed individuals, by condition, can then be used
as a proxy for the beneﬁts that might be realized if improved trans-
portation access enables disadvantaged individuals to access better
health care. From this preliminary work, based on study of asthma
and heart disease, great potential has been found for net societal ben-
eﬁts accruing from improving the quality of life of this transportation-
disadvantaged population by increasing its access to NEMT.
The authors thank the Transportation Research Board for its support
of this work via TCRP Project B-27. The authors also thank Casey
Kangas, James Lee, and James Bologna of the Altarum Institute for
their assistance in this work.
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