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Staff at DAP Health, a health center in Palm Springs, California, works with a patient in DAP Health’s “Get Tested Coachella Valley” Mobile Unit which provides free HIV testing and more. Health centers have relied on mobile units to take health services into communities, and now may be able to do more, thanks to recent legislative changes. (Photo by Donnie Lloyd Hedden Jr. for Direct Relief)
Editor’s note: This article is part of a joint editorial initiative between the National Association of Community Health Centers and Direct Reliefto deliver trusted and reliable content about health care.
Mobile medical units are traveling across city lines to reach rural and underserved residents in need of medical care. According to the National Association of Community Health Centers, the number of health centers using mobile health units has increased by 40% since 2019. That increase is expected to continue in 2024 when new MOBILE Health Care legislation will take effect and allow federally qualified health centers to use new grant dollars on mobile units. Health centers have used mobile units in the past to meet patients where they are for their dental, emergency services, family planning, and general medical care, with great success.
Rhonda Johnson has seen that firsthand. She runs a mobile unit that provides mammograms to patients in underserved communities in rural Nevada that otherwise might go without. “Eighty-seven percent of the towns where people love to live are in rural Nevada, but they don’t have access (to health care) that the cluster cities have. So what about everyone else?”
The Mammovan brings cancer screening to rural areas of Nevada. (Courtesy photo)
The Nevada Health Center has operated the Mammovan since 2000 to increase access to mammograms across Nevada. At the time, Nevada had one of the highest breast cancer rates in the country, with many women never having had a mammogram prior to being diagnosed. The Mammovan was a pioneering program among health center mobile units that has survived on philanthropic dollars.
Johnson said it costs about $1.5 million to put the van on the road and $1.2 million for operations. The travel burden is the heaviest cost, due to maintenance on the vans, and easy burnout on employees who are subject to constant travel throughout the state.
The Mammovan sets up in the Walmart parking lot in Winnemucca, a town of about 8,400 people in rural northern Nevada. The van is able to bring screenings to patients that might otherwise go without. (Courtesy photo)
Beginning in 2024, the MOBILE Health Care Act allows health centers to use new access grant program dollars for mobile health units. Under the new legislation, the expanded access will allow dollars to be spent to provide care in rural and underserved communities. Prior to the legislative change, the grant program forbade health centers from using grant dollars on construction costs or to expand services through mobile units.
Rep. Susie Lee (D) of Nevada introduced the bill to the House in August of 2021 and Sen. Jacky Rosen (D) of Nevada introduced it to the Senate. The House bill quickly passed with overwhelming bipartisan support and was approved in a 414-to-7 vote on September 29.
“The pandemic laid bare longstanding inequities in our health care system, and I’m fighting to make health care more accessible to Nevadans, no matter where they live. Federally Qualified Health Centers provide essential care for thousands of Nevada families who need it. With the passage of this bill, we’re one step closer to ensuring that every Nevadan has access to the care they deserve,” Lee said in a press release from her office about the legislation. Lee’s district is home to the Mammovan, which employs 10 people who work to increase access to mammograms across the state.
Under the guise of the new legislation, Nevada Health Center hopes to purchase another van so that one will travel the southern tier of the state, a second will remain in the Las Vegas area, and a third will travel the northern portion of the state. Johnson said this method will reduce the time employees will be required to stay on the road, travel costs, and overall van maintenance.
The Mammovan hasn’t traveled during the winter months due to variations in weather, but the additional money could improve travel capabilities. “That’s three months [the patients] lose out on,” Johnson said.
Though there was widespread support to expand the use of grant dollars, Congress must approve a budget for health centers to see more financial support.
“In order for it to really work, you have to have money,” said Deila Davis, deputy director of federal affairs for the National Association of Community Health Centers. “Health Centers receive a lot of federal money, and this is one more string for them to operate under.”
Davis said mobile units help health centers build trust with patients, remove transportation barriers, and increase job availability.
Patients are screened and seen at mobile units stationed in Guayanilla, Puerto Rico, in the aftermath of Hurricane Fiona on October 1, 2022. The units were operated by staff from Med Centro health center and purchased by Direct Relief after Hurricane Maria. (Photo by Alejandro Granadillo for Direct Relief)
In Puerto Rico, mobile medical units were used to support residents affected by Hurricane Fiona in 2022. In Mississippi, mobile units have been used to provide care for women in rural areas who need maternal healthcare, and across Florida in partnership with school districts where students don’t have consistent health care or regular access to pediatric care.
Patients are screened and seen at mobile units stationed in Guayanilla, Puerto Rico, in the aftermath of Hurricane Fiona on October 1, 2022. (Photo by Alejandro Granadillo for Direct Relief)
In a report published by the National Library of Medicine, mobile health units were described as favorable due to their flexibility of where patients can receive care, their ability to meet the evolving health needs of a community and address the social determinants of health.
“MHCs (Mobile Health Clinics) produce significant cost savings and represent a cost-effective care delivery model that improves health outcomes in underserved groups,” the authors wrote.
Florida’s PanCare Health Center has 12 mobile health units that travel to five school districts and several Head Start programs across nine counties to visit 15,000 students each year.
Robert Thompson, chief operating officer of PanCare Florida, said their mobile school health program allows students to have regular vision screenings dental exams, and annual physicals—much of which is required for students enrolled in local school systems. Of the 12 units, three are dental vans, seven are medical units, and two are used for optometry.
PanCare Health’s Dental Mobile Unit serviced 8,732 patients in 2019 in the surrounding community and school districts. Direct Relief has been a partner of PanCare since 2009, awarding them a Recovery and Resiliency Community Health Grant of $440,879 which helped cover emergency operating expenses during Hurricane Michael, purchase a mobile dental unit, as well as a panoramic x-ray unit and dental operations and supplies. (Photo by Donnie Lloyd Hedden for Direct Relief)
The mobile program employs 20 people, some seasonally and some year-round. Thompson said using grant dollars could allow them to employ more people and purchase another mobile unit. According to Thompson, the dental mobile health unit is in high demand, but all of the mobile units are driven at high costs to the health center. “We run them so much more than what they are designed for,” he said. “We have maintenance issues often because they are campers basically and we have problems because we use them so much, but it’s needed.”
Thompson said the majority of the students seen through the mobile school health program don’t visit the health center’s brick-and-mortar locations. Parents aren’t always able to leave work in the middle of the day and not every student has reliable transportation to get to the center. Meeting the students at their schools has created consistent access to medical care.
“It does stress the importance of regular care,” he said. “It’s not just a one-time thing; for a lot of these kids, it becomes their regular dental check-up. And it’s interactive, they have videos about how to brush your teeth and floss, and they get a to-go bag with a toothbrush and floss to continue using when they’re finished.”
PanCare Florida has also used the mobile units at local events, to support veterans, and migrant workers who often don’t have health insurance or transportation to visit the health center. “If we had funding available right now, especially dental, within six months we could probably have it full (of patients),” Thompson said. “There’s a lot more opportunity out there.”
Direct Relief has funded the purchase of dozens of mobile health units across the United States to support the efforts of health centers beyond clinic walls, including after disasters such as Hurricanes Harvey, Irma, and Maria.
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