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August 21, 2019

Why older patients don't take Uber and Lyft (and how providers can change that)

Daily Briefing

    Uber and Lyft are betting big on the health care sector to expand their businesses, but they are having to adopt new approaches to attract older U.S. residents, Paula Span writes for the New York Times' "The New Old Age."

    4 ways hospitals can provide transportation assistance to drive access improvements

    Why Uber and Lyft are betting on health care

    Uber executives have indicated the company wants to move deeper into providing patients with rides to medical appointments, and Lyft executives have identified the health care industry as a major source of new customers.

    Uber argues that expanding into health care is a win-win for both the company and the industry. Patient no-shows cost the health care industry an estimated $150 billion per year, and research shows a lack of transportation plays a large role in those missed appointments. Uber thinks it can help to close that gap.


    Similarly, Lyft believes it can offer patients a reliable medical transportation option. It has partnered with many of the industry's largest health plans to provide transportation to their members, and it recently announced that it was expanding its collaboration with the Blue Cross Blue Shield Institute to provide rides to Medicare Advantage members.

    Both companies also have experimented with programs to provide wheelchair-accessible transportation to disabled and older adults who have mobility issues. For instance, Uber Assist trains drivers in 20 cities on how to offer additional help to individuals who use canes, folding wheelchairs, and walkers, although the company requires that riders must be able to enter and exit vehicles independently.

    Older adults are apprehensive about using Uber, Lyft

    But research shows seniors are less likely than other adults to engage with ride-sharing services, Span writes.

    For instance, the Pew Research Center found that, while the share of adults ages 50 and older who use ride-hailing apps has increased from 7% in 2015 to 25% in 2018, it remains far lower than the 50% of adults ages 18 to 29 who use such apps.

    The problem is not simply that seniors do not have the necessary technology. Research from Pew shows more than half of adults over age 65 own smartphones, and Donna Nettleton—a volunteer at the Oasis Institute in Shiloh, Illinois, who teaches older adults how to use digital devices—says her students are eager to learn how to use Facebook and other smartphone apps.

    According to Span, the key barrier appears to be concerns about data security. "Uber and Lyft are scarier because they involve money," Nettleton explained.

    According to Span, older adults, who often are warned about identity theft and scams, are afraid they will lose money if they misuse ride-sharing apps. An AARP survey last year found two-thirds of adults older than 50 said they were unlikely to use ride-hailing apps because they had concerns about safety and privacy.

    Even so, there is growing evidence that older adults can learn how to use mobile apps to take "networked transportation" to attend fitness classes, medical appointment, and other activities.

    For instance, University of Southern California (USC) researchers enrolled 150 older adults with chronic conditions, transportation issues, and an average age of 72 in a study to examine whether they would use Lyft after being trained on how to use its app. The researchers offered three months of free ride-sharing services, and they found nearly all of the study participants took advantage—using Lyft for an average of 69 trips each. They also reported an improved quality of life.

    The study did, however, highlight money as a barrier. The USC researchers found one-fifth of the study participants said they would not use Lyft after the study period due to the cost.

    How Uber, Lyft are reaching out to older adults 

    In an effort to address older adults' financial and data security concerns, Uber and Lyft are beginning to contract with third parties, including health systems and senior living facilities, that can request rides on seniors' behalf, Span writes.

    Case managers and social workers in some organizations can request rides from Uber Health and Lyft to transport patients to and from medical clinics or offices, according to Span. For instance, at Brookdale Senior Living, the nation's largest senior living facility chain, front desk staff will order Lyft rides for residents and bill the resident directly or include the ride's cost as part of a monthly fee.

    What's next for senior ride-sharing?

    Joseph Coughlin, director of the M.I.T. AgeLab, said Uber, Lyft, and other ride-hailing applications have "great potential" to help older adults with transportation. He said, "There's been so painfully little innovation in transportation for the aging population that anything we do can only be an improvement."

    Dan Trigub, who heads Uber Health, said Uber also can potentially help hospitals generate savings and improve patient satisfaction. He said, "Hospitals may spend millions on taxi vouchers. Uber is cheaper, and we see higher patient satisfaction."

    However, Alexandre Bayen, director of the Institute of Transportation Studies at the University of California, Berkeley, expressed concerns about patients not being able to access ride-hailing apps outside of metropolitan areas. "The rural population might not see this for a long time," he said.

    Bayen said he would like to see public-private partnerships and public policies to expand access to ride-hailing across the United States (Span, "The New Old Age," New York Times, 8/16).

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