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Research Questions

  1. What are the current challenges of NEMT?
  2. What role can RB-NEMT play in the health care access ecosystem?
  3. In which circumstances is RB-NEMT most appropriate?

Ridesharing apps have changed how people get around. Its use in nonemergency medical transportation (NEMT) is nascent but possibly growing. The authors of this report build on existing research on health care access to describe NEMT challenges that rideshare-based NEMT (RB-NEMT) may address for those who need NEMT by identifying rider and ride types most appropriate for RB-NEMT. Population estimates for these profiles are drawn from three nationally representative sources.

The authors found that RB-NEMT could help reduce system strain and satisfy an unmet or poorly met need for on-demand cost-effective solutions within the NEMT ecosystem. Current RB-NEMT capabilities are most appropriate for individuals with medical conditions that result in the need to request rides and those who use Door2Door, Curb2Curb, or Area2Area (e.g., bus stop–to–bus stop) services. RB-NEMT is also most appropriate for in-patient and outpatient discharges, on-demand rides, requests for rides in which the scheduled mode failed to arrive, and rides requiring minimal assistance or monitoring.

The authors recommend more research on (1) RB-NEMT outcomes and the efficiency of programs targeting potential users and (2) the size, distribution, and projections for required transportation services, especially for vulnerable populations. The authors argue that policymakers should recognize that (1) transportation is a fundamental component of health care access and NEMT is a central pathway of ensuring access to vulnerable populations and (2) rideshare is a generally unique, economical, efficient, and otherwise unoccupied niche of the NEMT ecosystem, although the specific pathways to incorporating rideshare into NEMT will vary by state.

Key Findings

Transportation barriers mean barriers to health care access

  • The inability to get to a medical appointment or showing up late costs the health care system billions of dollars.
  • NEMT fills this transportation gap.
  • State Medicaid and some Medicare Advantage plans cover NEMT service, but this varies widely by state.
  • NEMT historically has had issues with fraud, inefficiency, and poor user experience.
  • Transportation network companies (TNCs) may improve NEMT user experience and efficiency.

Barriers to transportation differ among populations

  • Barriers can result from physical, cognitive, or sensory health limitations of a patient or logistical barriers.
  • These barriers can result in real changes to transportation patterns, such as avoiding public transit and asking others for rides.
  • RB-NEMT is a potential mode of transportation for those with medical or logistical barriers.

Levels of service need to be determined based on user needs

  • Questions to ask before assigning a level of service include (1) how ambulatory is a patient on their own, (2) how much assistance is needed to carry items, and (3) can they travel alone?

Some rides work better for RB-NEMT

  • This includes urban rides, situations in which the timing of discharge is uncertain, peak hours, situations in which the scheduled option was late or a no-show, and last-minute needs.
  • It is unknown if riders and rides who would most benefit from NEMT and specifically RB-NEMT are being routed to that service.

NEMT, and transportation in general, is a means to an end

  • An individual's health and well-being depend on reliable NEMT.

Recommendations

  • Conduct more research on RB-NEMT outcomes and the efficiency of programs targeting potential users.
  • Conduct more research on the size, distribution, and projections for required transportation services, especially for vulnerable populations, such as older adults, individuals with disabilities, and rural dwellers.
  • Policymakers should recognize that transportation is a fundamental component of health care access and NEMT is a central pathway of ensuring access to vulnerable populations.
  • Policymakers should recognize that rideshare is a generally unique, economical, efficient, and otherwise unoccupied niche of the NEMT ecosystem, although the specific pathways to incorporating rideshare into NEMT will vary by state.

Table of Contents

  • Chapter One

    Rideshare and Nonemergency Medical Transportation

  • Chapter Two

    Who Are the Transportation Vulnerable? Characteristics of Potential NEMT and RB-NEMT Users

  • Chapter Three

    Which Riders Are Best for RB-NEMT?

  • Chapter Four

    Which Rides Work Best for RB-NEMT?

  • Chapter Five

    Optimizing RB-NEMT Through Policy and Process

  • Appendix A

    Data Set Descriptions

  • Appendix B

    Expert Contributions

Research conducted by

The research described in this report was prepared for Lyft Healthcare and conducted by the Community Health and Environmental Policy Program within RAND Social and Economic Well-Being.

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