Abstract
IMPORTANCE: Geographic distance to medical care is often thought to create obstacles to access. However, little is known about acceptable travel times for routine medical care and how willingness to travel varies by the type of medical services and individual characteristics. OBJECTIVE: To survey older adults in the US to determine the limits for acceptable travel times to primary care, specialty care, and diagnostic procedures and to investigate the factors associated with their willingness to travel. DESIGN, SETTING, AND PARTICIPANTS: In this survey study using a discrete choice experiment, a survey was fielded to participants of a nationally representative internet panel (the Understanding America Study) between April 23 and June 8, 2025. Understanding America Study panelists aged 65 years or older were eligible and invited to participate. MAIN OUTCOMES AND MEASURES: The primary outcomes were current and maximum acceptable travel times to primary care, specialty care, and one-time diagnostic services. Linear regression was used to explore the associations between respondent characteristics and willingness to travel. RESULTS: Of the 3390 individuals invited, 2650 respondents were included in the study (78.2% response rate). Respondents had a mean (SD) age of 72.9 (6.0) years; 1377 (52.0%) were female, and 1366 (51.5%) had an annual household income of more than $60 000. The median willingness to travel times were 67.5 (IQR, 37.5-112.5) minutes, 127.5 (IQR, 67.5-232.5) minutes, and 112.5 (IQR, 67.5-202.5) minutes for primary care, specialty care, and one-time diagnostic appointments, respectively. The majority of respondents were willing to travel at least 1 hour to receive primary care (1597 [60.3%]), specialty care (2237 [84.4%]), or one-time diagnostic care (2185 [82.5%]). Regression results revealed that individuals who had higher incomes and greater educational attainment, racial and ethnic minority individuals, and those who typically drove themselves to appointments were willing to travel longer durations; for example, those with incomes greater than $60 000 would travel 22.6 (95% CI, 13.3-31.9) more minutes to specialty care than those with lower incomes. Respondents who lived in metropolitan areas, those who reported being in fair or poor health, and those who reported difficulty traveling to medical appointments in the past were willing to travel shorter durations; for example, those who self-reported fair or poor health were willing to travel 15.0 (3.9-26.1) fewer minutes to specialty care appoints than those with better self-reported health. CONCLUSIONS AND RELEVANCE: The findings of this survey study suggest that older US adults were willing to travel for substantial durations before delaying or forgoing routine medical care, with important differences by appointment type and individual characteristics. Future research can explore willingness to travel for other types of medical appointments or procedures or for other populations.