Long ambulance response times, costly and unreliable non-emergency transportation, and insufficient insurance coverage for travel-related health care expenses are among the key findings of a new report released by the University of Hawaiʻi Rural Health Research and Policy Center (UH RHRPC).

“The Impacts of Transportation and Travel Access on Rural Health in Hawaiʻi” underscores the widespread challenges faced by residents in rural and neighbor island communities when trying to access timely and affordable health care, and offers policy solutions to address barriers.

Although about 30% of Hawaiʻi’s population lives in rural areas spread across six publicly inhabited islands, most specialty care is located on Oʻahu. The report found that residents of Molokaʻi and Lānaʻi routinely face flight delays or cancellations, often missing urgent medical appointments and waiting months for rescheduling.

The report also highlights gaps in insurance coverage, especially for patients who do not qualify for Medicaid, and the high out-of-pocket costs for travel, lodging, and food associated with medical visits. Maternal-fetal health services are particularly challenging, with some pregnant patients needing to relocate from neighbor islands to Oʻahu for prenatal and delivery care or risk emergency medevac transport.

“Improving access will require coordinated efforts across health care, transportation and policy sectors,” said John Desfor, UH RHRPC policy and data analyst. “We hope this research will guide meaningful action to improve transportation access for health care in rural communities across Hawaiʻi.”

Some of the shared policy options to address these challenges include:

• Enhance emergency air and ground ambulance fleets
• Support community paramedicine programs and expand primary care teams
• Mandate non-emergency medical transportation coverage in Medicare and private/employer-based insurance in Hawaiʻi
• Establish a grant program for community-based organizations to support housing for maternal-fetal patients relocating for prenatal and delivery care
• Support regional health hubs and mobile maternal health clinics in rural areas
• Expand interisland flight programs and explore cost-effective and sustainable alternative modes of transportation for health services
• Address airline reliability concerns and increase airline competition by leveraging the U.S. Department of Transportation Essential Air Service program
• Enable hospitals and clinics to be reimbursed for transportation

The four-part report features a literature review, interviews with 40 stakeholders, policy recommendations and a focused sub-report on maternal-fetal telehealth.

“We appreciate the significant community engagement in this project from start to finish,” said Aimee Grace, UH RHRPC principal investigator and UH Strategic Health Initiatives director. “Many stakeholders met with our team to share their stories or contribute context and policy ideas. We look forward to working together to share these policy options further.”

The Hawaiʻi Public Health Institute will host a webinar on this project on August 18, 2025, noon–1 p.m. (register here).