Transportation Insecurity, Chronic Illnesses, and Healthcare Access: Associations with Telehealth Utilization, Homecare Visits, and Well-Being

Background/Objectives: Transportation insecurity and chronic health conditions can substantially influence healthcare access and alternative in-person healthcare utilization in urban areas. Alternative healthcare delivery models, such as telehealth services and professional homecare visits, may help address mobility-related barriers. This study examines how transportation insecurity, chronic health status, and healthcare access challenges are associated with homecare visits and telehealth utilization, while also assessing differences in health and well-being perceptions among individuals with and without chronic health conditions in Dallas, Texas, and Detroit, Michigan. Methods: A cross-sectional survey design was employed among 1649 respondents using a questionnaire. Binary logistic regression analyses were conducted to examine associations between transportation insecurity, chronic health status, healthcare access challenges, homecare visits, and telehealth utilization. Mann–Whitney U tests were used to compare perceived physical health and mental health between participants with and without chronic health conditions. Results: Transportation insecurity emerged as having a significant relationship with homecare visits, with transportation-insecure respondents being approximately 4.7 times more likely to receive homecare services than transportation-secure respondents. Transportation insecurity and healthcare access challenges were also significantly associated with greater telehealth utilization in Detroit and both cities combined. Participants without chronic health conditions reported significantly more favorable perceptions of physical and mental health than those with chronic conditions. Transportation affordability, lack of available rides from family or friends, and long waiting times were identified as the most common healthcare transportation barriers. Conclusions: Healthcare utilization and well-being outcomes are significantly associated with self-reported chronic health status and transportation insecurity. Expanding transportation assistance programs, strengthening homecare services, and improving telehealth availability may enhance healthcare access and support better health outcomes among transportation-disadvantaged and chronically ill populations.