Kotani: Transportation Issues in Rural Healthcare
Dear Editor,
We read with great interest the recently published paper by Choi et al. [1], which highlighted the inconvenience of transportation as a major barrier to the accessibility of healthcare for older people living in rural areas. Of note, the authors mentioned the need to consider public transportation to healthcare institutions in the Discussion section [1]. The authors also pointed out that the use of public transportation has received little attention in Korea relative to other countries, such as the United Kingdom [1]. This issue is very important for maintaining and improving the health and welfare of residents of rural communities worldwide [2]. We would like to add some comments on the current situation in Japan to contribute to further discussion of this topic.
The inclusion of public transportation in rural healthcare policies has not been thoroughly examined in Japan, similarly to the situation in Korea. In rural communities, buses are the means of public transportation most familiar to residents. A prime example is the community bus, which drops off riders at various clinics within the community and makes stops at hospitals (Figure 1). On-demand taxis and/or rideshare taxis are other means of transportation, although their use is often studied from a private rather than public perspective, and in urban areas rather than rural areas [3]. Rural governments should consider investing more resources into improving transportation services and systems. Simultaneously, at the level of the national government, collaborative action between the Ministry of Health, Labour and Welfare (which has jurisdiction over rural healthcare) and the Ministry of Land, Infrastructure and Transport (which has jurisdiction over transportation) is needed.
Rural communities are rapidly aging, and aging-related declines in the physical and/or cognitive function of older rural residents have made it difficult for them to visit healthcare institutions and/or retain their driver’s licenses [4,5]. This matter therefore needs to be discussed urgently.


The author has no conflicts of interest associated with the material presented in this paper.

Figure. 1.
An image of a community bus.


1. 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):355-365.
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2. Del Rio M, Hargrove WL, Tomaka J, Korc M. Transportation matters: a health impact assessment in rural New Mexico. Int J Environ Res Public Health 2017;14(6):E629.
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3. Santi P, Resta G, Szell M, Sobolevsky S, Strogatz SH, Ratti C. Quantifying the benefits of vehicle pooling with shareability networks. Proc Natl Acad Sci U S A 2014;111(37):13290-13294.
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4. Anton SD, Woods AJ, Ashizawa T, Barb D, Buford TW, Carter CS, et al. Successful aging: advancing the science of physical independence in older adults. Ageing Res Rev 2015;24(Pt B):304327.
5. Ichikawa M, Inada H, Nakahara S. Increased traffic injuries among older unprotected road users following the introduction of an age-based cognitive test to the driver’s license renewal procedure in Japan. Accid Anal Prev 2020;136: 105440.