From 2013 to 2017, the median household income in Ward 8 was $31,954. Forty-six percent of households in Ward 8 had no vehicle. Twenty-six percent of Ward 8’s population reported “fair” or “poor” health status, compared with the District’s overall mean of 13 percent. The District as a whole ranks nationally among the states with the lowest rates of “fair” or “poor” health status; Ward 8’s percentage ranks this community alongside states with some of the worst health statuses.
D.C. Mayor Muriel E. Bowser (D) signed agreements for a new hospital in Wards 1 and 8. The D.C. Council must approve the funding in June. Though the city is looking at reduced revenue because of the novel coronavirus pandemic, it cannot afford to walk back this promise to residents of Ward 8.
The lack of adequate health care forces those in Ward 8 to travel for care, most often to the MedStar Washington Hospital Center, MedStar National Rehabilitation Hospital, Children’s National Hospital and the Washington DC VA Medical Center. There are, however, no public transportation options to get there. Of the Washington Metropolitan Area Transit Authority’s 269 bus lines, zero serve Ward 8. No Metro station is within a mile of the hospitals, making it too far to walk for those in poor health.
Across the country, 3.6 million Americans per year miss or delay essential medical care because of transportation barriers. At a micro level, this forgone care results in worsening health outcomes. These worsening outcomes may render individuals disabled and unable to work, further disconnecting them from high-quality care, creating a self-perpetuating cycle of poor health. At a macro level, this forgone care contributes to an estimated annual burden of more than $150 billion to our national health-care system. I fear the impact this transportation crisis has on individuals and on the system as a whole.
There are currently fragmented approaches to increase access. D.C. Medicaid beneficiaries can receive free non-emergency medical transportation. MedStar Health partners with Uber to streamline ride-hailing for patients; this applies only to those visiting a MedStar Health facility.
D.C. policymakers must address the transportation barrier for those east of the Anacostia. These changes fall into three major strategy categories: transportation services, community-based point of care and health-center infrastructure. To improve transportation services, the D.C. government could create bus lines serving Ward 8 and medical campuses. Alternatively, policymakers could establish cost-sharing agreements with hospitals to fund private transportation for those without access. Or, the government could provide vouchers for free or reduced-fare taxis or provide mileage reimbursements for friends and family members who take patients to and from appointments.
Community-based point-of-care solutions could include District-funded mobile clinics that deliver care where patients live and work, bringing providers to patients instead of the other way around. D.C. policymakers could partner with telehealth providers to provide clinical care at a distance — something more providers are doing during this pandemic.
Health-center infrastructure solutions include developing one-stop shops for health, where a variety of health-care services and social services exist under one roof. Another infrastructure solution is changing or extending hours of operation to include weekends or evenings when friends or family are most available to provide rides.
To break this self-perpetuating cycle of poor health, D.C. policymakers must improve health-care access and transportation options for residents east of the Anacostia River. The cost of the improvements will be more than offset by the decrease in spending associated with a healthier population. Until access equity is achieved, the 68 square miles of the District will continue to act as two separate states: one with some of the lowest rates of fair and poor health, and one with some of the highest.