Hawaiʻi Rural Health Suffers from Transportation Gaps

Report Details Critical Access Issues and Proposes Solutions

Accessing essential medical care in Hawaiʻi’s rural and neighbor island communities is fraught with challenges, according to a new report. Long ambulance wait times, unreliable non-emergency transport, and inadequate insurance for travel expenses hinder residents from receiving timely treatment.

Transportation Woes Impact Island Residents

The University of Hawaiʻi Rural Health Research and Policy Center (UH RHRPC) released findings highlighting significant hurdles for those outside of Oʻahu. Many residents, particularly on Molokaʻi and Lānaʻi, endure flight delays or cancellations, causing them to miss vital medical appointments and face lengthy waits for rescheduling.

Specialty care is predominantly located on Oʻahu, meaning a substantial portion of Hawaiʻi’s population living in rural areas must travel considerable distances for services not available locally. This creates a cascade of problems, from missed appointments to increased financial burdens.

Maternal Care and Insurance Gaps

The report emphasizes the particular difficulties faced by expectant mothers. Some pregnant individuals are compelled to relocate to Oʻahu for prenatal and delivery care, while others risk emergency medical evacuations. Insurance coverage limitations, especially for those not qualifying for Medicaid, exacerbate these issues, leading to high out-of-pocket costs for travel, accommodation, and meals associated with medical visits.

“Improving access will require coordinated efforts across healthcare, transportation and policy sectors.”

—John Desfor, UH RHRPC Policy and Data Analyst

The UH RHRPC suggests several policy avenues to mitigate these problems. These include bolstering emergency air and ground ambulance services, supporting community paramedicine, and mandating non-emergency medical transportation coverage in both Medicare and private insurance plans within Hawaiʻi.

Proposed Policy Solutions

Further recommendations propose establishing grant programs for community organizations to assist with housing for expectant mothers needing to relocate for care. The report also advocates for strengthening regional health hubs and mobile maternal health clinics in underserved areas.

Expanding interisland flight programs and exploring more cost-effective transportation alternatives for health services are also key suggestions. The report calls for addressing airline reliability issues and increasing competition, potentially by utilizing federal programs like the U.S. Department of Transportation’s Essential Air Service program. Enabling healthcare facilities to be reimbursed for patient transportation is also proposed.

This comprehensive study, funded by the Hawaiʻi State Department of Health Office of Primary Care and Rural Health, involved a literature review, interviews with 40 stakeholders, and policy recommendations, including a specific sub-report on maternal-fetal telehealth. The full report is available on the UH RHRPC website.

“We appreciate the significant community engagement in this project from start to finish. 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.”

—Aimee Grace, UH RHRPC Principal Investigator and UH Strategic Health Initiatives Director

The Hawaiʻi Public Health Institute will host a webinar on August 18, 2025, from noon to 1 p.m. to discuss the project’s findings. Registration is available online.