Center for Injury Research and Prevention

Exploring A Transportation Barrier to Healthcare

November 25, 2019
Nina Joyce Brown University Nina R. Joyce, PhD, a researcher and professor with the Brown University School of Public Health

A note from Allison E. Curry, PhD, MPH: Today we are pleased to welcome a guest blog post from Nina R. Joyce, PhD, a researcher and professor with the Brown University School of Public Health, with whom I am collaborating on research to remove transportation barriers for improved access to healthcare.

Did you know that 80 percent of driver's license suspensions are due to non-driving-related events, such as failure (or inability) to pay a court fee or fine? At the same time, approximately 3.6 million Americans miss or delay healthcare each year because of transportation barriers. This lack of access to care can lead to serious short-term and long-term health issues.[1]

In an editorial I recently co-authored with colleagues from the Brown University School of Public Health and the Center for Injury Research and Prevention at Children’s Hospital of Philadelphia published in the American Journal of Public Health, we explore the potential impact of non-driving-related driver's license suspensions on access to healthcare and health outcomes. We also offer a call to action for public health researchers to provide much-needed evidence.

Lacking access to a vehicle is the most commonly reported transportation barrier to care. When we envision a person with a suspended driver’s license, we tend to think of one who has run a red light, driven way above the speed limit, or gotten behind the wheel while intoxicated. Rarely do we picture a person in a minimum wage job unable to take a day off to appear in court regarding an unpaid ticket for a broken tailpipe or parking violation. Yet, the majority of driver's license suspensions are for a non-driving-related event, such as failure to pay a court fee or appear in court. Evidence suggests that these non-driving-related suspensions are disproportionately imposed on low-income and racial and ethnic minority drivers who are already more likely to face other barriers to care.[2,3]

Although six states have passed legislation banning driver's license suspensions for non-driving-related events, others may be hesitant to take this step given the lack of available information on this population and the effects of these suspensions. More research is needed to understand the impact of non-driving-related driver's license suspensions on access to healthcare and health outcomes. By measuring the prevalence of non-driving-related driver's license suspensions across both individual- and systems-level factors, we can develop better policies that work to mitigate the impact of these suspensions on healthcare utilization, particularly in communities already facing other barriers to accessing healthcare.

Changing Policy to Improve Health and Well-Being

Developing better policies also requires us to work across agencies whose primary objectives might not be related to health. For instance, driver's license suspension policies are in fact effective at getting people to pay the fines they owe, and agencies may be hesitant to give up one of the few tools they have for collecting revenue. But, when a fine is the same whether a person makes $10 per hour or $1,000 per hour, the fine becomes a form of regressive taxation. Our incomes are taxed progressively, why shouldn’t fines and fees be as well?

However, there’s an even better economic argument for amending driver's license suspension policies to account for ability to pay: Most people who don’t pay their fine or fee are unable, not unwilling, to pay it. In 2018 the Federal Reserve reported that 44 percent of the US population would be unable to pay an unexpected expense of $400. And, of those who could afford to pay, a third could only do so in lieu of other necessary expenses, such as rent or mortgage, groceries, or utility bills. Thus, these policies don’t impact just a small segment of the population, they have implications for almost half of all US adults.

In our work we advocate for a “Health in All Policies” approach to addressing license suspension policies.[4] Research has shown that driver's license suspensions lead to unemployment, which can be costly for states in terms of a reduced tax base (fewer people paying income tax); but more importantly, these policies can lead to increased spending on social services, including Medicaid.

In order to fully understand the financial and health implications of non-driving-related driver's icense suspensions, we need more comprehensive information on suspended drivers, their access to healthcare before these suspensions, and available resources to mitigate the potentially harmful effects of these policies on their health outcomes.

Sources

[1] Syed ST, Gerber BS, Sharp LK. Traveling Towards Disease: Transportation Barriers to Healthcare Access. J Community Health. 2013;38(5):976-993.

[2] Driven by Justice Coalition. Opportunity Suspended: How New York’s Traffic Debt Suspension Laws Disproportionately Harm Low-Income Communities and Communities of Color. 2019.

[3] Lurie N, Dubowitz T. Health Disparities and Access to Health. JAMA. 2007;297(10:1118-1121.

[4] Ribgy E. How the National Prevention Council Can Overcome Key Challenges and Improve Americans’ Health. Health Affairs. 2011;30(11):2149-2156.

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