The evaluation and cost-benefit analysis of a nonemergency private transportation program for low-income adults in a rural setting

Access to transportation can improve the health of communities. Since 2015, Project TRIP (Transporting Residents with Innovative Practices) has offered free nonemergency privately operated individualized transportation for low-income residents in rural eastern North Carolina. We sought to evaluate the impact of Project TRIP on health outcome and healthcare utilization measures and to conduct an economic evaluation of its cost benefit. Key health outcome and healthcare utilization variables were compared across 101 Project TRIP users before and after TRIP participation via data obtained from electronic health records from 2017 to 2021. The cost-benefit analysis included a comparison of the costs of operating Project TRIP as compared to the savings of fewer hospital and emergency department admissions. Pre and post TRIP comparisons were analyzed on the following: A1C scores, no show/missed appointments, body weight, body mass index, and number of emergency room and hospital admissions. Over half (58%) of Project TRIP users were female with a mean age of 54. Most riders were Black (69%), either received Medicaid (32%) or Medicare (17%) or were uninsured (22%). All variables showed a decrease (improvement) post TRIP utilization. The average A1C level decreased by 0.52 post TRIP utilization (statistically significant at 10% level). The number of hospital admissions also decreased (statistically significant at 1% level) for TRIP users. Other key measures also improved for TRIP users but not at statistically significant levels. The estimated net savings of Project TRIP in hospital and emergency room visits alone after deducting operating costs in the past 5 years was $720,544. This study found that access to a non-emergency medical transportation program was cost-effective in reducing emergency room and hospital expenditures. Project TRIP users demonstrated an improvement in health outcomes post TRIP utilization. Expanding model rural transit programs and policies are needed. • Transportation insecurity affects those living in rural eastern North Carolina. • An individualized transportation program improved health and decreased emergent care. • A sizable cost-benefit was found in reduced emergency room and hospital visits alone.