Patients Can Now Ride-Hail To the Hospital

It’s been estimated that 3.6 million Americans miss or show up late to doctor’s appointments each year due to a lack of reliable transportation. That’s a public health problem: Skipped tests and check-ups mean lost diagnoses, lapsed prescriptions, and wasted time and money on the part of the healthcare system.

But the transportation landscape is changing. With about 75 percent of the U.S. population living in a county with access to an on-demand ride-hailing service, some patients are turning to Uber and Lyft as a means to medical care, whether it’s because they lack a car, live far from transit, or simply prefer not to drive. Now, Uber is making the relationship official. On Thursday, the company announced the launch of Uber Health, a platform that will allow healthcare providers to call their patients Uber rides to and from appointments, all using the Uber interface. Starting this week, the service will be available in the 250 cities where Uber operates.

Using the new Uber Health dashboard, medical providers can coordinate pick-ups and drop-offs for their patients. When it’s time for a pickup, users are notified via text message (accessible on flip phones and iPhones alike) and given a link to track drivers on a map. For riders who don’t use mobile phones, there’s an analog version: Healthcare administrators can provide paper print-outs with passenger pick-up locations, driver license plate numbers and car models. The rides can be scheduled minutes before a meeting, or up to 30 days in advance; the costs will be covered by providers themselves.

From a driver standpoint, nothing changes. The Uber Health app is HIPPA compliant, which means all medical information is kept private. On a trip to the hospital, a driver won’t know whether a rider is traveling to the hospital using the traditional Uber app—to visit a loved one, for example—or is meeting a doctor through the healthcare platform. “In the interest of patient privacy we’re not sharing any additional information beyond what’s necessary,” said Jay Holley, Uber’s head of partnerships.

Even before the Uber Health pilot began eight months ago, ride-sharing apps had already begun to disrupt the healthcare transportation sphere. In 2016, Uber partnered with the nonprofit healthcare system MedStar Health and the medical transport start-up Circulation to book rides and set appointment reminders. Lyft also joined forces with National MedTrans Network, a non-emergency medical transportation service, to expand their coverage network.

Elsewhere, Uber’s public health effects have emerged more accidentally. In October, economists from the University of Kansas found that when Uber starts operating in a city, the volume of ambulance calls decreases significantly. They inferred that in the event of a medical emergency (at least one that doesn’t require stabilization en route to a hospital), people often find it preferable to call a ride-sharing service rather than an ambulance. The appeal seemed to be two-fold: Ubers took an average of three minutes to arrive in urban areas to ambulances’ eight, and even at the highest “surge” levels cost much less than ambulance bills. That’s why cities, including Washington, D.C., are pursuing policies that nudge hospital-bound travelers into Ubers or similar ideas, such as Memphis’ paramedic-hailing service.

Holley notes that Uber Health is not intended to “disrupt” the ambulance industry. Indeed, individual Uber trips won’t likely replace ambulance use either, according to economics professor David Slusky. They could actually free up more emergency vehicles for people with life-threatening conditions in need of truly urgent care. “If we had infinite ambulances, we could take everybody in them, and therefore if somebody had a situation where an ambulance would save their life they’d always be in one,” he said. “But we don’t have them.” To pick up the slack, Uber could help.

The results of a trial period suggest as much. Uber Health has been tested in about 100 hospitals since July. One of them, Georgetown Home Care, which connects elderly patients in Washington, D.C. with in-home non-medical care, has used the service to transport patients to doctors’ appointments with caregivers by their side. Before the trial began, caregivers were already using UberX with patients, sometimes daily. Now, instead of ordering one Uber ride at a time as they did pre-Uber Health, office administrators can control and track a fleet of 50 cars at any given moment. “It’s an effective way of getting clients to appointments and moving them around the city in a safe way,” said John Bradshaw, Georgetown’s CEO.

Elderly patients can be wary of getting into a car with a stranger, according to Bradshaw. But the status quo isn’t ideal, either. Not all caregivers have access to a car, nor do they all know how to drive. And even when they do, “typically what’s going to happen is [caregivers] have to drop them at the door, leave them, find a parking spot,” said Bradshaw. “Potentially, if that client has dementia, you’re hoping they’re still there [when you go out to meet them].” But with a dedicated Uber driver, the caregiver is never without the client.

NYU Langone, a cancer center in New York City, has also used Uber Health to transport women undergoing breast cancer treatment between ambulatory care centers and the operating room.  It’s a quick trip that doesn’t require an ambulance, but for patient comfort, a subway isn’t ideal. Uber, however, “has been a good alternative to the normal car service that we have used in the past,” Jamie Liptack, an NYU Langone communications officer, explained. The platform is easier to navigate, and drivers are cheaper to hire.

Uber’s benevolent streak hasn’t emerged in a vacuum. The decision to offer rides that ostensibly save lives comes on the heels of several public dings to the brand: former CEO Travis Kalanick’s ouster, data breaches, and sexual harassment, and wage theft claims. On Thursday, researchers from MIT released a study showing that Uber and Lyft drivers earn a median profit of $3.37 an hour, far below minimum wage. Reputation aside, the app isn’t perfect. It may be a challenge to track drivers in infrastructural labyrinths like a medical complex. Nor is it perfectly safe: While Uber conducts background checks on all drivers, the company doesn’t do any extra vetting of Uber Health drivers, Holley said, citing HIPPA protections.

It’s also not yet clear how Uber Health would interface with Medicaid. Conceivably, providers could charge an Uber bill to Medicaid, just as they would another healthcare transportation option, such as a bus pass or paratransit shuttle. An Uber representative said that no medical providers using Uber Health have tried to do this yet. But it matters whether they’ll start. Many of the lowest-income Americans who don’t have adequate transportation access may also be insured by Medicaid and Medicare, if they’re insured at all.

Furthermore, while Uber’s reach is vast, it is not comprehensive. Rural areas with few on-demand drivers and few modes of public transportation—communities with some of the worst healthcare gaps in the country—will miss out on the benefits of this particular innovation.

Still, in cities, many patients are manifestly in need of better ways to get around. In Columbus, Ohio, for example, the city’s frail bus network barely connects to the parts of town with the worst health disparities, including staggering rates of infant mortality. As CityLab has previously reported, it’s no mystery why 23 percent of women  with prenatal appointments at Columbus’ free clinics don’t make it to the doctor. At least for some, an all-expenses-paid, on-demand ride could make the difference between sickness and health.