Introduction: A nine-cent public taxi ride service was introduced to improve public transportation in the rural county of Seocheon, which has an ageing population. This study investigated the effect of this policy on the levels of healthcare utilization in individuals with diabetes aged 65 years or above. Methods: The Korea National Health Insurance System claims data from January 2006 to May 2013 (pre-intervention) and June 2013 to December 2014 (post-intervention) were used. The treatment group consisted of patients residing in Seocheon, and the control group consisted of patients residing in neighbouring areas with a similar demographic composition. The difference-in-difference approach was used to estimate differences in levels of healthcare utilization between the treatment and control groups before and after the intervention period. Results: The introduction of public taxi transportation service was associated with an increase in outpatient visits. Specifically, the number of outpatient visits to public health centres increased, whereas those to tertiary hospitals decreased. The number of inpatient visits to general hospitals also increased. Conclusion: The results of this study confirm a relationship between the introduction of public taxi transportation services and increased healthcare utilization in older patients with diabetes in rural areas. These findings are noteworthy considering the importance of continuous care in managing chronic diseases.

Choe SH. ‘It’s a godsend’: 9-cent taxi rides in rural South Korea. The New York Times. 2021.
Starbird LE, DiMaina C, Sun CA, Han H-R. A systematic review of interventions to minimize transportation barriers among people with chronic diseases. J Community Health. 2019;44(2):400–11.
Bove AM, Gough ST, Hausmann LRM. Providing no-cost transport to patients in an underserved area: impact on access to physical therapy. Physiother Theor Pract. 2019;35(7):645–50.
Okoro C, Strine T, Young S, Balluz L, Mokdad A. Access to health care among older adults and receipt of preventive services. Results from the behavioral risk factor surveillance system, 2002. Prev Med. 2005;40(3):337–43.
Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013 Oct;38(5):976–93.
Statistics Korea. 2020Population and housing census. Republic of Korea: DaejeonStatistics Korea; 2021.
Kim KW, Kim OS. Super aging in South Korea unstoppable but mitigatable: a sub-national scale population projection for best policy planning. Spat Demogr. 2020 Jul;8(2):155–73.
Kang S, Seo Y. Developing the DRT service (public taxi operation) in rural areas. Sejong, Republic of Korea: Korea Transport Institute; 2017.
Atella V, Piano Mortari A, Kopinska J, Belotti F, Lapi F, Cricelli C, et al. Trends in age-related disease burden and healthcare utilization. Aging Cell. 2019 Feb;18(1):e12861.
Fenton JJ, Von Korff M, Lin E, Ciechanowski P, Young B. Quality of preventive care for diabetes: effects of visit frequency and competing demands. Ann Fam Med. 2006;4(1):32–9.
Mattson J. Transportation, distance, and health care utilization for older adults in rural and small urban areas. Transportation Res Rec. 2011;2265(1):192–9.
Kullanit A, Taneepanichskul N. Transportation barriers on healthcare utilization among elderly population living in mahasarakham province, Thailand. J Health Res. 2017;31:233–8.
Choi Y, Nam K, Kim CY. Association between convenience of transportation and unmet healthcare needs of rural elderly in Korea. J Prev Med Public Health. 2019;52(6):355–65.
Shin JY. Trends in the prevalence and management of diabetes in Korea: 2007–2017. Epidemiol Health. 2019;41:e2019029.
Kim AM, Cho S, Kim HJ, Jung H, Jo MW, Lee JY, et al. Primary care patients’ preference for hospitals over clinics in Korea. Int J Environ Res Public Health. 2018 May 30;15(6):1119.
Dimick JB, Ryan AM. Methods for evaluating changes in health care policy: the difference-in-differences approach. JAMA. 2014 Dec 10;312(22):2401–2.
Hyun KR, Kang S, Lee S. Does long-term care insurance affect the length of stay in hospitals for the elderly in Korea? A difference-in-difference method. BMC Health Serv Res. 2014;14(1):630–7.
Stuart EA, Huskamp HA, Duckworth K, Simmons J, Song Z, Chernew ME. Using propensity scores in difference-in-differences models to estimate the effects of a policy change. Health Serv Outcomes Res Methodol. 2014;14(4):166–82.
Chaiyachati KH, Hubbard RA, Yeager A, Mugo B, Shea JA, Rosin R. Rideshare-based medical transportation for medicaid patients and primary care show rates: a difference-in-difference analysis of a pilot program. J Gen Intern Med. 2018;33(6):863–8.
Liu GG, Tang C, Liu Y, Bu T, Tang D. Will high-speed railway influence the healthcare seeking behaviour of patients? Quasi-experimental evidence from China. Health Policy Plan. 2021;36(10):1633–43.
Kwak SK, Kim JH. Statistical data preparation: management of missing values and outliers. Korean J Anesthesiol. 2017 Aug;70(4):407–11.
Kutz TL, Roszhart JM, Hale M, Dolan V, Suchomski G, Jaeger C. Improving comprehensive care for patients with diabetes. BMJ Open Qual. 2018;7(4):e000101.
Morita K, Inokuchi R, Jin X, Ishikawa M, Tamiya N. Patients’ impressions of after-hours house-call services during the COVID-19 pandemic in Japan: a questionnaire-based observational study. BMC Fam Pract. 2021 Sep;22(1):184.
Fu H, Curtis BH, Xie W, Festa A, Schuster DP, Kendall DM. Frequency and causes of hospitalization in older compared to younger adults with type 2 diabetes in the United States: a retrospective, claims-based analysis. J Diabetes Complications. 2014;28(4):477–81.
Rosenthal TC, Fox C. Access to health care for the rural elderly. JAMA. 2000;284(16):2034–6.
Kotval-K Z, Keilman L, Wang W. Transportation services for older adults and preventive healthcare attainment. Urban Sci. 2020;4(3):38.
Statistics K. Results of the agriculture, forestry and fishery survey in 2016.
Rijken M, Bekkema N, Boeckxstaens P, Schellevis FG, De Maeseneer JM, Groenewegen PP. Chronic Disease Management Programmes: an adequate response to patients’ needs? Health Expect. 2014 Oct;17(5):608–21.
Kim AM, Cho S, Kim HJ, Jo MW, Eun SJ, Lee JY. Rethinking the role of the public health clinic: comparison of outpatient utilization in the public health clinics and private clinics in Korea. Int J Environ Res Public Health. 2018 Jun 22;15(7):1312.
Song Y. The South Korean health care system. Jpn Med Assoc J. 2009;52:206–9.
You do not currently have access to this content.