By Olivia Lewis
Editor’s note: This article is part of a joint editorial effort between National Association of Community Health Centers and Direct Relief to provide trusted and reliable healthcare content.
Mobile medical units travel 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 47% since 2019. This increase is expected to continue through 2024, when new MOBILE health legislation goes into effect and will allow federally qualified health centers to use new grant dollars for mobile devices. In the past, health centers have used mobile units to meet patients where they are for their dental, emergency services, family planning and general medical care, with great success.
Rhonda Johnson has seen this first hand. She runs a mobile unit that provides mammograms to patients in underserved communities in rural Nevada who would otherwise go without. “Eighty-seven percent of the towns people like to live in are in rural Nevada, but they don’t have the access (to health care) that cluster towns do. What about everyone else?’
The Nevada Health Center has operated Mammovan since 2000 to increase access to mammograms throughout Nevada. At the time, Nevada had one of the highest rates of breast cancer in the country, with many women never getting a mammogram before being diagnosed. Mammovan was a pioneering program among mobile health center units that survived on philanthropic dollars.
Johnson said it costs about $1.5 million to get the van on the road and $1.2 million for operations. The burden of travel is the biggest expense, due to van maintenance and the easy burnout of employees who are subject to constant travel across the state.
Beginning in 2024, the MOBILE Health Act allows health centers to use new program dollars to provide access for mobile health units. Under the new legislation, expanded access will allow dollars to be spent on providing care in rural and underserved communities. Before the legislative change, the grant program prohibited health centers from using grant dollars for construction costs or expanding services through mobile units.
Congresswoman Susie Lee (D) of Nevada introduced the bill in the House in August 2021, and Senator Jackie Rosen (D) of Nevada introduced it in the Senate. The Senate bill quickly passed with overwhelming bipartisan support and was approved by a vote of 414-7 on September 29.
“The pandemic has exposed longstanding inequities in our health care system, and I am fighting to make health care more accessible to Nevadans, no matter where they live. Federally qualified health centers provide essential care to thousands of Nevada families who need it. With the passage of this bill, we are one step closer to ensuring that every Nevadan has access to the care they deserve,” Lee said in a news release from his office about the legislation. Lee’s area is home to Mammovan, which employs 10 people working to increase access to mammograms across the state.
Under the guise of the new legislation, the Nevada Health Center hopes to purchase another van so that one will travel in the southern part of the state, a second will stay in the Las Vegas area and a third will travel in the northern part of the state. Johnson said this method would reduce the amount of time employees would have to stay on the road, travel costs and overall maintenance of the vans.
Mammovan has not traveled during the winter months due to weather changes, but the extra money could improve travel options. “It’s been three months [the patients] lose,” Johnson said.
Although there was broad support for expanding the use of grant dollars, Congress must approve a budget for the health centers to see more financial support.
“For it to really work, you have to have money,” said Dayla Davis, deputy director of federal affairs for the National Association of Community Health Centers. “Health centers get a lot of federal money, and that’s another string they have to work under.”
Davis said the mobile units help health centers build trust with patients, remove transportation barriers and increase availability.
In Puerto Rico, mobile medical units were used to assist residents affected by Hurricane Fiona in 2022. In Mississippi, mobile units were used to provide care to rural women in need of maternal health care, and throughout Florida in partnership with school districts where students do not have ongoing health care or regular access to pediatric care.
In a report published by the National Library of Medicine, mobile health units were described as beneficial because of their flexibility in where patients can receive care, their ability to meet the evolving health needs of the 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 populations,” the authors write.
Florida PanCare Health Center has 12 mobile health units that travel to five school districts and several Head Start programs in 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 dental appointments for vision screenings and annual medical exams — much of which are required for students enrolled in local school systems . Of the 12 units, three are dental vans, seven are medical and two are for optometry.
The mobile program employs 20 people, some seasonally, others year-round. Thompson said using grant money could allow them to hire more people and purchase another mobile device. According to Thompson, the dental mobile health unit is in high demand, but all mobile devices are driven at a high cost to the health center. “We run them way beyond what they’re designed for,” he said. “We often have maintenance issues because they’re basically campers and we have issues because we use them so much, but it’s necessary.”
Thompson said the majority of students seen through the mobile school health program do not visit physical health center locations. Parents can’t always leave work in the middle of the day, and not every student has reliable transportation to get to the center. Meeting students at their schools created ongoing access to medical care.
“It really highlights the importance of regular care,” he said. “This is not just a one-time thing; for many of these children, it becomes their regular dental appointment. And it’s interactive, they have videos on how to brush and floss and they get a takeout bag with a toothbrush and floss to keep using when they’re done.”
PanCare Florida also uses the mobile units at local events to support veterans and migrant workers who often do not have health insurance or transportation to visit the health center. we could probably fill it (with patients),” Thompson said. “There’s a lot more opportunity out there.”
Direct Relief funds the purchase of dozens of mobile health units across the United States to support the efforts of health centers outside the walls of clinics, including after disasters such as Hurricanes Harvey, Irma and Maria.