GEOGRAPHIC ACCESS TO HEALTHCARE AMONG OLDER ADULTS: NATIONAL ESTIMATES OF TRAVEL BURDEN IN MEDICARE
Author(s)
Jie Chen, PhD.
Professor and Chair, University of Maryland, College Park, MD, USA.
Professor and Chair, University of Maryland, College Park, MD, USA.
OBJECTIVES: Geographic access is a fundamental dimension of healthcare access, yet little is known about the cumulative travel burden older adults experience when obtaining care. Rural populations may face particular challenges because of provider shortages, transportation barriers, and longer distances to care. This study quantified healthcare travel burden among community-dwelling Medicare fee-for-service (FFS) beneficiaries and examined differences by rurality and dual-eligibility status.
METHODS: We analyzed 2023 national Medicare enrollment and claims data for community-dwelling FFS beneficiaries aged 65 years and older. Travel distance was calculated between beneficiaries' residential ZIP codes and healthcare providers for inpatient, outpatient, and physician services. Outcomes included travel distance per visit and cumulative annual travel burden. Beneficiaries were classified by rural versus metropolitan residence and dual-eligibility status. Descriptive analyses summarized travel burden across populations.
RESULTS: Substantial variation in travel burden was observed across healthcare settings and populations. Rural beneficiaries consistently traveled farther than metropolitan beneficiaries for inpatient, outpatient, and physician services. For inpatient care, approximately 17% of rural beneficiaries accumulated more than 120 miles of annual travel compared with approximately 10% of metropolitan beneficiaries. Similar patterns were observed for outpatient care, where rural beneficiaries were disproportionately represented in higher-distance categories. Although most physician visits occurred close to home, a subset of beneficiaries accumulated substantial travel burden because of frequent visits. Across all settings, rural beneficiaries were more likely to experience high cumulative travel distances. Dual-eligible beneficiaries also experienced considerable travel burden.
CONCLUSIONS: Medicare beneficiaries experience substantial travel burden in obtaining healthcare, with the greatest burden concentrated among rural populations. These findings highlight persistent geographic disparities in healthcare access and suggest that travel burden is an important but often overlooked dimension of healthcare accessibility. Efforts to improve local service availability, strengthen care coordination, and expand telehealth may help reduce travel-related barriers and improve access to care for older adults.
METHODS: We analyzed 2023 national Medicare enrollment and claims data for community-dwelling FFS beneficiaries aged 65 years and older. Travel distance was calculated between beneficiaries' residential ZIP codes and healthcare providers for inpatient, outpatient, and physician services. Outcomes included travel distance per visit and cumulative annual travel burden. Beneficiaries were classified by rural versus metropolitan residence and dual-eligibility status. Descriptive analyses summarized travel burden across populations.
RESULTS: Substantial variation in travel burden was observed across healthcare settings and populations. Rural beneficiaries consistently traveled farther than metropolitan beneficiaries for inpatient, outpatient, and physician services. For inpatient care, approximately 17% of rural beneficiaries accumulated more than 120 miles of annual travel compared with approximately 10% of metropolitan beneficiaries. Similar patterns were observed for outpatient care, where rural beneficiaries were disproportionately represented in higher-distance categories. Although most physician visits occurred close to home, a subset of beneficiaries accumulated substantial travel burden because of frequent visits. Across all settings, rural beneficiaries were more likely to experience high cumulative travel distances. Dual-eligible beneficiaries also experienced considerable travel burden.
CONCLUSIONS: Medicare beneficiaries experience substantial travel burden in obtaining healthcare, with the greatest burden concentrated among rural populations. These findings highlight persistent geographic disparities in healthcare access and suggest that travel burden is an important but often overlooked dimension of healthcare accessibility. Efforts to improve local service availability, strengthen care coordination, and expand telehealth may help reduce travel-related barriers and improve access to care for older adults.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD32
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Health Service Delivery & Process of Care
Disease
Geriatrics