Coordination of health and human service transportation programs in rural communities provides a source of sustainable funding for public transit. Significant funding is available for non-emergency medical transportation (NEMT) for Medicaid-eligible clients. In 2009, 21 of the 39 rural transit districts in Texas received NEMT funds under the Texas Medical Transportation Program (MTP). The benefits of MTP funds to rural transit districts are an additional funding source, a consistent cash flow through regular reimbursement for MTP services, and the opportunity to maximize resources (vehicles, miles, hours) by combining MTP passenger trips with general public transit. However, MTP may also increase resources required (miles, hours) to deliver transportation due to program service requirements, resulting in a higher cost per passenger trip and reduced productivity due to longer trip lengths and time. The purpose of this research is to develop a resource-based cost allocation methodology to accurately reflect cost and resources by MTP and general public passenger trip and apply the methodology to five case studies to analyze the impact of MTP trips on general public transit service. Results of the case study analysis reveal that in four of the five case studies, MTP is more resource intensive than general public transportation. MTP passenger trips have longer trip lengths than general public trips ranging from additional mileage per passenger trip of 13 to 40 miles. Using a resource-based cost allocation methodology, in four of the five case studies, MTP trips have higher operating cost per boarding as compared to general public service ranging from a difference of $12 to as much as a $32 per passenger trip. Four of the five case study rural transit districts do not cover the full cost of providing MTP service with MTP revenues with a shortfall ranging from approximately $6.00 per passenger trip to $19.00 per passenger trip. The cumulative impact of MTP on the Texas Performance Funding Formula was found to be positive resulting from the significant positive impact on the local investment indicator. However, the additional funding generated by MTP in the funding formula is still not sufficient to compensate fully for the deficits found.

Prehospital management of patients who are traumatically injured within the state of Florida starts with the use of the Florida Adult Trauma Scorecard Methodology. The scorecard methodology may indicate that a patient is a Trauma Alert based on applied physiological and other judgment criteria. However, patients may be transported via Helicopter Emergency Medical Services (HEMS) without justified physiological needs. Rawls’ theory of justice posits that a fair and equal distribution of social resources is essential to public wellbeing. To evaluate this premise regarding prehospital trauma transports, archival 2015 data from the Florida Department of Health Trauma Registry was obtained. Using logistic regression, each trauma scorecard assessment criteria was individually and collectively evaluated regarding its predictive likelihood of a scene responder requesting HEMS versus ground ambulance transport. Controlling for trauma center locations, all five of the triage classifications illustrated a significant likelihood (p = 0.000) of HEMS transportation requests. Category 4 (EMS Judgment) predicted the highest likelihood of HEMS transport requests (b = 2.39, Wald X2(1) = 2026.88, OR = 10.9, p = .000, CI [9.83, 12.09]). Categories 4 (14.7%) and 6 (Local Criteria; [25.8%]) illustrated unexpectedly high percentages of emergency department discharge when Trauma Alert patients were HEMS transported. Over triage of patients to HEMS without meeting physiologic criteria provides less than an equal and fair distribution of public and private resources. State-level social change can be realized through HEMS transport criteria modifications applying more stringent application of physiologic patient condition scoring when determining the mode of prehospital scene response transport.