Older Americans will travel two hours for a specialist - but only if they can afford the trip

One hundred and twenty-eight minutes. That is how long the average American over 65 is willing to travel for a specialist appointment, according to a new study in JAMA Network Open. For a diagnostic test like an MRI, 113 minutes. For routine primary care, 68 minutes.

Those numbers are higher than many policymakers assume. But the averages conceal a divide that matters more than the means.

Who travels and who does not

Researchers at the USC Dornsife Center for Economic and Social Research surveyed a nationally representative sample of 2,650 adults aged 65 and older between April and June 2025. They asked how long respondents currently travel for care and how much farther they would go before deciding to delay or skip an appointment.

The gaps were predictable in direction but striking in size. Older adults with higher incomes, more education, and reliable access to a car reported substantially greater willingness to travel. Those in poorer health, residents of large metropolitan areas, and people who had previously struggled with transportation were significantly less willing.

Jeremy Burke, the study's first author and a senior economist at USC, framed the finding in terms of health equity: if someone is already dealing with health challenges or transportation barriers, even modest increases in travel time become real obstacles. Those are the patients most at risk of delaying care - and most likely to suffer consequences from delays.

The urban paradox

One counterintuitive finding: older adults in big cities were less willing to travel long durations than those in rural areas. This likely reflects the reality of urban travel - traffic, parking costs, navigating public transit with mobility limitations - which can make a 30-minute drive feel far more burdensome than the same distance in a rural setting with open roads and free parking.

Rural residents, already accustomed to long drives for basic services, appeared more accepting of extended trips. This does not mean rural access is adequate - it means rural patients have adapted to inadequacy. Tolerance is not the same as equity.

What this means for telehealth and system consolidation

Health systems are consolidating. Hospitals are closing in some areas. Specialty services are migrating to regional hubs. The assumption underlying these shifts is that patients will travel to where the care is. This study suggests many will - but not all, and not equally.

Telehealth is often presented as the solution to geographic barriers, and it does reduce travel burdens for some visit types. But virtual care cannot replace diagnostic imaging, physical examinations, or procedures requiring specialized equipment. For the most common reasons to see a specialist - a suspicious scan, an unexplained symptom, a treatment that requires hands-on assessment - telehealth is a complement, not a substitute.

Soeren Mattke, the study's senior author and director of the Brain Health Observatory at USC, put it directly: telehealth is an important tool, but not a cure-all. Systems still need to think carefully about where services are located and how patients physically reach them.

The transportation policy angle

Programs offering ride services, improved public transit routes to medical facilities, and partnerships with community organizations could meaningfully reduce the gap between those willing to travel and those unable to. Non-emergency medical transportation already exists through Medicaid in many states, but coverage varies and wait times can be prohibitive.

The study does not quantify how much travel burden would need to decrease to prevent care delays, nor does it track whether expressed willingness to travel translates into actual behavior. There is a well-documented gap between what people say they will do in a survey and what they do when an appointment requires a two-hour round trip on a Tuesday morning.

The bottom line for health planning

Distance alone is not the story. The type of visit, the patient's resources, their health status, and the practical logistics of getting from home to clinic all shape whether an appointment happens or gets skipped. As care delivery models evolve, matching services to the actual travel capacity of the population they serve - rather than to an assumed average - will matter for outcomes.