For some patients, transportation plays such a big role in accessing health care that it could be the deciding factor on whether they visit their doctors.

One demographic that might be most affected by relying on public transit is the safety net population, or people who do not have health insurance or are underinsured, said Mark Hernandez, chief medical officer of the Community Care Collaborative.

"It is very clear that the ability to actually go to a health care venue will have a fairly direct impact on the outcomes of health in that population," he said. "It is more than just whether or not a given facility is on a given bus line."

Many people in the safety net population do not have paid time off from their employer, making the process of getting to a doctor much more challenging, he said.

"It is much easier to just choose not to engage in health care, so that is really the inherent challenge in transportation as it relates to health care because we've made transportation difficult for a certain class of population—namely by financial class. We've disincentivized their engaging in health care," Hernandez said.

For those in the safety net population who are not employed, a different set of challenges exist, he said. For example, a mother of three children who does not have her own vehicle might have to take her children with her to see a doctor or go to a pharmacy, and it can be less convenient and more time-consuming.

To address the challenge of patients needing more convenient access to health care facilities, agencies such as Capital Metro are becoming more involved in health care planning. Capital Metro Senior Planner Jennifer Golech said the organization was heavily involved in providing input for the Austin/Travis County Health and Human Services Department's Community Health Improvement Plan. The plan includes partnerships with agencies such as Central Health, St. David's Foundation and Seton Healthcare to help improve patient wellness and provide people with better access to transportation.

In addition to CHIP, Capital Metro is also involved in the Regional Transportation Coordination Committee. Part of the effort includes a Transit-Friendly Development Guide that could be provided to developers who are looking for land to acquire for health care facilities or other types of agencies, Golech said. The guide would include what types of development work best to provide transit.

Golech said Capital Metro's buses serve most health care facilities in Austin. Capital Metro Communications Specialist Melissa Ayala said the transportation organization has more than 80 fixed bus routes in Austin.

"There are a lot of options out there, and there are resources to help connect patients with tools to help them find the best route to their clinic," Ayala said.

Health care facilities that are difficult for Capital Metro to provide service to include property on frontage roads because buses cannot serve the property in both directions, Golech said. Health care facilities such as University Medical Center Brackenridge that are closer to Central Austin have higher ridership and are easier to serve with transit, she said. Brackenridge is served by three high-frequency bus routes that cover a large geographic area, as opposed to the St. David's North Austin Medical Center that only has one route because it is outside of the main transit corridor, she said.

Golech said it could be beneficial for health care facilities and Capital Metro to work together in the beginning stages of development so that health care agencies know Capital Metro's requirements to provide transit.

Addressing the transportation challenge might also need to be taken up by those in the heath care system, Hernandez said. As the system is changing to become more focused on improving patient health, he said people in the health care system need to think about what is included in their responsibilities.

For example, if a patient with severe diabetes goes to the hospital once or twice a month, it could cost the health care system and the public about $500,000 per year. However, if the health care system included transportation in its responsibilities by allocating funding for taxi cabs or bus passes or sending a physician to a patient's home, patient care could cost less.

"By paying for transportation or by arranging for transportation, which allows the patient to receive primary care on a regular basis, hospitalizations could be avoided," Hernandez said.