Rideshare-Based Medical Transportation for Medicaid Patients
and Primary Care Show Rates: A Difference-in-Difference Analysis
of a Pilot Program
Krisda H. Chaiyachati, MD
, Rebecca A. Hubbard, PhD
, Alyssa Yeager, MD
Judy A. Shea, PhD
, Roy Rosin, MBA
, and David Grande, MD
VA Advanced Fellow at the Cpl. Michael Crescenz VA Medical Center, Philadelphia, PA, USA;
Leonard Davis Institute of Health Economics,
University of Pennsylvania, Philadelphia, PA, USA;
Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia,
Yale-New Haven Hospital, New Haven, CT, USA;
Massachusetts General Hospital, Boston, MA, USA;
Division of General Internal Medicine
at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;
Penn Medicine Center for Health Care Innovation,
Philadelphia, PA, USA.
BACKGROUND: Transportation to primary care is a well-
documented barrier for patients with Medicaid, despite
access to non-emergency medical transportation (NEMT)
benefits. Rideshare services, which offer greater conve-
nience and lower cost, have been proposed as an NEMT
OBJECTIVE: To evaluate the impact of rideshare-based
medical transportation on the proportion of Medicaid pa-
tients attending scheduled primary care appointments.
DESIGN: In one of two similar practices, all eligible Med-
icaid patients were offered rideshare-based transportation
(Brideshare practice^). A difference-in-difference analytical
approach using logistic regression with robust standard
errors was employed to compare show rate changes be-
tween the rideshare practice and the practice where
rideshare was not offered (Bcontrol practice^).
PARTICIPANTS: Our study population included resi-
dents of West Philadelphia who were insured by Medicaid
and were established patients at two academic general
internal medicine practices located in the same building.
INTERVENTION: We designed a rideshare-based trans-
portation pilot intervention. Patients were offered the
service during their reminder call 2 days before the
appointment, and rides were prescheduled by research
staff. Patients then called research staff to schedule
their return trip home.
MAIN MEASURES: We assessed the effect of offering
rideshare-based transportation on appointment show
rates by comparing the change in the average show rate
for the rideshare practice, from the baseline period to the
intervention period, with the change at the control
KEY RESULTS: At the control practice, the show rate
declined from 60% (146/245) to 51% (34/67). At the
rideshare practice, the show rate improved from 54%
(72/134) to 68% (41/60). In the adjusted model, control-
ling for patient demographics and provider type, the odds
of showing up for an appointment before and after the
intervention increased 2.57 (1.10–6.00) times more in
the rideshare practice than in the control practice.
CONCLUSIONS: Results of this pilot program suggest
that offering a rideshare-based transportation service
can increase show rates to primary care for Medicaid
KEY WORDS: access to care; socioeconomic factors; Medicaid;
underserved populations; primary care.
J Gen Intern Med 33(6):863–8
© Society of General Internal Medicine 2018
Low-income patients frequently face transportation barriers in
accessing primary care. In several large surveys, 24–51%
reported missing or rescheduling an outpatient appointment
because of lack of access to transportation.
costs (e.g., affordability of transport), physical factors (e.g.,
requiring a wheelchair-accessible vehicle or mobility assis-
tance getting from their room to the vehicle), availability
(e.g., car ownership or living near transit stops), and reliability
(e.g., timeliness of pick-ups and drop-offs).
face transportation barriers tend to shift their care toward more
costly, acute care settings for low-acuity needs, for reasons of
preference and convenience.
For providers, missed ap-
pointments have a negative effect on clinical productivity, with
disjointed care or missed treatment opportunities.
used clinical space and staff time equate to lost revenue.
Non-emergency medical transportation (NEMT) is a benefit
available for Medicaid beneficiaries to help overcome trans-
portation barriers. Despite the availability of this service,
however, transportation barriers remain substantial for Medic-
aid patients for a number of reasons.
First, patients may
not be aware of how to access the service. Enrollment often
requires social work intervention and the completion of forms
to designate eligibility. Second, states place various restric-
tions on the service, including the number of rides, types of
rides (public transit, taxis, or shared vans, depending on avail-
ability), and ride distance.
These limits create wide
Received June 8, 2017
Revised December 1, 2017
Accepted December 28, 2017
Published online January 29, 2018