By JOE MKHITARYAN

We spend a lot of time talking about who has health insurance. I think we need to spend more time asking who can actually use it.

You can approve an appointment, find a specialist and cover the treatment. But if the patient cannot get out of the house and into the right vehicle, none of that gets them to the doctor.

I have been in the medical transportation business since 2010. I built my businesses in Southern California, where a few miles on a map can turn into a long trip in traffic. Running these operations has taught me to ask questions that are easy to miss when you are looking at a transportation budget.

Can the patient walk? Can they sit upright? Are there stairs outside the home? Do they need a wheelchair vehicle or a gurney? Who is bringing them back?

Those answers determine whether the ride will work. They need to be settled before a vehicle arrives.

Non-emergency medical transportation, or NEMT, is how many patients reach appointments when they cannot get there on their own. It is easy to describe it as a ride. Providing it is more involved.

Take a gurney trip. In our operation, that means sending two staff members. They have to help the patient safely, load and secure the gurney, make the trip and complete the handoff. Then there is the return. That crew is working well before the vehicle starts moving and after it stops.

If you price that trip mainly by the miles driven, you leave a lot of the work out of the calculation.

I pay attention to this because I am the one paying wages, insurance and vehicle expenses. I have a business interest in the rates. But anyone responsible for patient access should care whether those rates can support the service they expect. You cannot keep asking for trained staff and dependable vehicles without considering what it costs to provide them.

Of course, paying more does not automatically produce better service. Providers should have to show that they are safe, reliable and doing the work they bill for. The question is whether the payment and the expectations make sense together.

The need is real.