It’s a sad paradox of the U.S. health care system: America spends more on health care than any other developed Western country, yet compared to those nations, Americans are in poorer health.
In 2019, the U.S. spent $10,207 per capita on health care, more than twice the amounts of France, Canada, Australia, or the U.K., according to the health care foundation The Commonwealth Fund. Yet among the wealthiest countries, it has the highest rates of chronic diseases and obesity. It also has the lowest life expectancy.
One reason for America’s poor outcomes is that many of its most vulnerable populations have a hard time accessing its health care system. They may lack insurance or be inadequately insured. They may live long distances from any medical facilities or lack transportation altogether.
An effective way to bridge such gaps is to bring the doctor closer to the patient. That’s why providers around the country are serving the medically underserved with over 2,000 mobile health clinics, reports Advisory Board, a health care think tank. Collectively, they see 6.5 million Americans each year.
Patients who have visited a mobile clinic are 78% more likely to self-manage their conditions, according to a study in the International Journal for Equity in Health. They end up living healthier lives. Thus, mobile health clinics can play an important role in improving America’s public health outcomes.
What Is a Mobile Health Clinic?
What is a mobile health clinic? It’s a doctor’s office on wheels — a van, bus, or recreational vehicle that has been modified into a self-contained space for providing medical care. The vehicle is retrofitted with equipment, waiting rooms, and exam rooms.
Whatever the layout, the mission is the same: to travel to communities where residents don’t have convenient access to clinical-quality health care. Whether they’re packed into a city or scattered around the countryside, such communities have vulnerable individuals who are in danger of going without treatment.
When underserved people get easier access to care, studies have found, they’re less likely to miss appointments or skip medications. They’re more likely to get chronic diseases diagnosed early, like high blood pressure or diabetes, reducing the risk that those conditions will lead to morbidities and death.
Mobile clinics can provide a wide variety of services, depending on the needs of the populations they serve. Common services are:
- Preventive care, such as immunizations, lab work, mammograms, and screenings for conditions like diabetes
- Managing chronic conditions, like arthritis and heart disease, helping to keep patients out of the hospital
- Basic dental work, such as X-rays, cleanings, and fillings
- Vision exams and fittings for eyeglasses
If a community has unique needs, a mobile health clinic can customize itself to meet them. For example, the New Mexico Mobile Screening Program for Miners provides specialized services for ailments specific to miners. It offers chest X-rays, spirometry testing of lung capacity, and screenings for hearing loss.
When a patient needs a service a mobile clinic doesn’t provide, it can sometimes meet the need through telemedicine. An internet connection can bring a specialist remotely to a patient, instead of requiring the patient to travel to meet with the specialist.
How Mobile Health Clinics Help Underserved Populations in Health Care
The U.S. Health Resources & Services Administration (HRSA) defines underserved populations in health care as those whose communities lack access to primary care. Around the country, it counts 83 million Americans living in 7,290 underserved areas.
What do underserved populations look like? Figures from HRSA and the Mobile Health Map, a nationwide database of mobile clinics, paint this picture:
- Economically, 71 million are low-income.
- Geographically, 56 million are rural and 27 million are urban.
- Children up to age 17 make up 41% of clients, followed by adults 45 to 64 years of age at 31%.
- Ethnically, 59% of clients are nonwhite, with Black and Latinx Americans making up the largest groups.
- Medicaid and Medicare cover 45% of patients, while 41% are uninsured.
What barriers keep these populations underserved, and how can mobile health clinics help to remove them? The Advisory Board, a health care think tank, highlights these obstacles:
- The barrier: A quarter of low-income patients have missed or rescheduled appointments due to lack of transportation. Some of these patients, particularly those in rural areas, live in “medical deserts,” more than 60 minutes from an acute care facility. Others live in parts of cities that don’t have convenient public transit.
- The solution: When they can’t reach a doctor, a mobile health clinic brings a doctor to them.
Lack of Insurance
- The barrier: In 2019, 30 million Americans didn’t have health insurance. More than half of them didn’t have a regular doctor, and 20% had passed up necessary care because of costs.
- The solution: A mobile clinic allows uninsured patients to get seen and treated with clinic-quality care.
- The barrier: Another 42% of Americans are underinsured, meaning they can’t completely afford out-of-pocket expenses.
- The solution: At mobile health clinics, patients can receive the care they need for free or at sliding scale rates.
Lack of Trust
- The barrier: Among low-income Americans, 53% say they distrust doctors. They cite past experiences of high cost and inadequate treatment.
- The solution: A mobile clinic can offer an approachable and comfortable environment, along with workers who are sensitive to their clients’ cultures and values. The International Journal for Equity in Health writes, “Patients value MHCs’ informal setting, familiar environment, convenient location and staff who are easy to talk to. Because MHCs make the effort to physically drive into communities, community members feel that the clinics are reaching out to care about them.”
4 Types of Mobile Health Clinics
Nobody expects a single doctor to meet all of their medical needs. A typical person may see a primary care physician for their general health, but visit a dentist to take care of their teeth and an optometrist for eye exams.
For the same reason, different types of mobile clinics offer different kinds of care. Some real-life examples help to illustrate the four most common types, what kinds of facilities they house, and what areas of care they offer. While their levels of care are usually basic, they can meet surprisingly wide ranges of needs:
Mobile Outreach Clinics
In Orange County, California, the Hurtt Family Health Clinic supplements three stationary clinics with a free mobile outreach clinic. Essentially a primary care facility, it’s outfitted with the same equipment and laboratory facilities as the system’s other offices and provides a broad array of services:
- Treatment of minor injuries like sprains and insect bites, as well as common illnesses like colds and fevers
- Screenings for breast tumors, osteoporosis, cancer, and heart disease
- Pregnancy testing
- Preventive care, from vaccinations to help with quitting smoking
- Management of chronic conditions like high cholesterol
- Free and reduced-price medications through an onboard pharmacy
Other mobile outreach clinics provide services such as wellness checks, sports physicals, and health education.
Mobile Dental Clinics
Tioga County, New York, sends a mobile dental clinic, named Tioga Smiles, to schools and other public locations around its largely rural area. Students can get appointments during the school day, while adults can get dental work done before and after school hours.
The van offers basic dental services, including cleaning, filling, and extracting teeth. The program also helps children prevent tooth decay by applying sealants to teeth and varnishing with fluoride. Like most mobile dental clinics, it doesn’t provide root canals or other forms of oral surgery.
Besides dentists’ chairs, the array of equipment in a mobile dental clinic may include X-ray machines and sterilization systems.
Mobile Eye Clinics
In the wake of the 2005 hurricanes Katrina and Rita, thousands of U.S. Gulf Coast residents were left without glasses or contact lenses. VSP Vision Care assisted them by creating a mobile eye clinic called Eyes of Hope. It provided a temporary facility in which local eye doctors could get back to work.
Today, VSP’s mobile fleet has three vehicles that travel all over the country — often to natural disaster sites like that of the 2018 Paradise, California, wildfire. Over 15 years, its mobile eye clinics have seen 2 million people.
Each vehicle includes an exam room, a dispensary with popular brands of frames, and an optical finishing lab that cuts lenses to mount in frames. A patient can often get an exam, fitting, and finished pair of glasses, all in the same day.
Mobile Veterinary Clinics
In the District of Columbia, the Humane Rescue Alliance runs a 33-foot, mobile veterinary clinic that can handle up to 20 animals at a time. On the outside, the diesel bus features pictures of some of its canine and feline patients. On the inside, it’s fitted with two operating tables, a treatment area, and cages. It can hook up to an electric source or run independently on a generator.
The mobile clinic can accommodate almost any procedure that would be performed at a brick-and-mortar animal hospital, from routine surgeries like spaying and neutering to dental care, wellness exams, and end-of-life services.
The mobile clinic minimizes the stress of transporting animals to the HRA’s regular veterinary hospital, which can harm their health. It has the added benefit of freeing up space at the central facility, enabling the overall system to treat more creatures in need.
How to Start a Mobile Health Clinic
Anyone interested in how to start a mobile health clinic should know that it’s not as simple as installing equipment in a van and putting it on the road. The process can be every bit as complex and time-consuming as launching a conventional medical practice.
Like any business startup, careful planning of every aspect will help to make the project a success. Those aspects include design, finance, and marketing, as well as working with community organizations to pinpoint which vulnerable populations the clinic will serve and how best to serve them. Typical steps include the following:
Identifying Target Demographics
What low-income and minority groups are underserved in the community, and what are their most common health problems? Some information to look for:
- Listings in HRSA’s online directory of medically underserved communities and populations nationwide
- Emergency department utilization rates in the community — high rates suggest a need for more primary care to treat conditions before they become emergencies and which medical conditions might be most prevalent
- Routes and schedules for public transportation
- High rates of uninsured community members
Networking with Community Groups
Existing organizations in health and social services, both governmental and nonprofit, can provide valuable information about target populations and their needs. Once a mobile health clinic is up and running, they can refer potential patients. In turn, the clinic can refer patients to community groups for services that are social rather than medical.
Hiring Culturally Sensitive Staff
To overcome distrust of the health care system, having workers who can relate to clients as people, not just patients, is helpful. Hiring staff who have experience with target populations, their cultures, and, in some cases, their languages is also useful.
Securing a Medical Vehicle
The medical vehicle can be a self-contained van, bus, or truck, or a pull-behind trailer. Several manufacturers offer pre-designed vehicles for mobile health clinics. Many are customized for particular kinds of health services, such as dentistry, ophthalmic care, surgery, or imaging. Other dealers sell used vehicles designed for mobile health.
As an example, one typical mobile outreach clinic is built on a 30-foot truck chassis with two examination rooms, a reception room, and a bathroom. It can have two-wheel or six-wheel drive, depending on whether it will be driving on unpaved roads to rural locations. A team of five can set it up in less than 15 minutes.
Modifying a Nonmedical Vehicle
As an alternative to buying a pre-designed vehicle, a clinic can modify one to house a medical practice. It can be outfitted with equipment that’s specifically built to be moved and set up quickly.
It’s also good to consider what nonmedical equipment might be needed. Some useful features include awnings for working outside, wheelchair lifts for patients with disabilities, portable generators for locations without electric hookups, and telemedicine equipment.
Developing a Mobile Health Clinic Business Plan
A mobile health clinic is not just a vehicle; it’s a business. Like any business, it needs to have a plan, which needs to be periodically evaluated and updated.
Where a mobile health clinic business plan differs from a typical business plan is that its most important outcomes are not measures of finance but health.
At a minimum, a plan should seek to answer these questions:
What Will It Cost, and Who Will Pay?
The average cost of launching a mobile health clinic is $300,000, according to the Advisory Board. Gifts and grants from corporations, foundations, and universities typically cover the largest share of costs. Another common funding source is hospitals seeking to reduce the need for emergency services.
Once it’s in operation, the average mobile clinic costs $429,000 annually to run, reports Advisory Board. Identifying continuing revenue streams ahead of time to cover those costs is important. Besides philanthropy, they can include public and private insurance reimbursements, patient fees, and fundraising events.
Where Will It Park?
Community groups and government agencies can help to pinpoint locations that are convenient and comfortable for potential patients. Common locations are schools, libraries, parks, and community centers. Another consideration is whether the mobile health clinic will need access to power or water.
When Will It Operate?
Consistent scheduling is key to building interest and trust in a community. A plan should include how often to visit each location, with hours that meet residents’ existing routines.
How Will It Be Marketed?
Most mobile health clinics don’t do paid advertising. They rely on word-of-mouth recommendations, as well as flyers and posters. Partnering with community organizations can help to spread the word.
What Will the Measurable Goals Be?
A mobile health clinic business plan measures its goals in people served rather than money earned. It sets targets and assesses whether they’ve been met.
A critical measure, especially to funders, is return on investment. The Mobile Health Map offers a free online tool for calculating how much money the overall health care system saves by investing in a mobile clinic. Nationwide, the return is $12 for every $1 spent on mobile health care, according to Advisory Board.
Other typical metrics for mobile health clinics include:
- Number of patients seen or services provided
- Improvements in outcomes for specific diseases
- Reductions in chronic conditions that go unmanaged
- Satisfaction scores from patient surveys
Taking Health Care on the Road
With too many Americans falling through the cracks of the established system, mobile health clinics help to fill those gaps in public health. Many professionals go into health care because they have a passion for helping other people. Mobile clinics create a unique opportunity to help people who have been disadvantaged by income or geography.
But such clinics are both expensive and complicated to run. They face administrative challenges that a brick-and-mortar medical practice does not.
A degree program like the online Master of Health Administration at Ohio University can help develop the mixture of health policy, administrative, and business skills needed to make a mobile health clinic succeed. Courses include Leadership of Health Organizations, Health Care Finance and Strategic Planning, and Marketing in Health Services. Explore the range of offerings to understand how Ohio University’s program can prepare you for taking health care on the road to some of the people who need it most.