How Mobile Health Clinics Advance Health Justice

Equitable access to healthcare is a key element to lessening the racial health disparities that have existed throughout the history of the United States. But how can we increase access to care when many communities of color lack hospitals and clinics? By thinking beyond traditional healthcare delivery models that require people to come to immovable buildings, advocates of health justice can bring healthcare to the people.

Mobile health clinics are customized vehicles that travel to communities to provide healthcare services, often to those who otherwise lack access or connection to healthcare systems. They can deliver a range of services adapted to the community’s unique needs such as dental care, primary care, preventive care and/or health screenings, chronic disease management, behavioral healthcare, substance use treatment, prenatal care, and pediatric care.

How can we provide greater access to care when many communities of color do not have hospitals and clinics?

Many mobile health programs provide free or low-cost services to patients and have proven successful in increasing access to primary healthcare services for underresourced areas that have seen shortages of primary care practitioners. Mobile health clinic programs have also been effective in reducing emergency department visits.

Many mobile health clinic programs successfully deliver culturally responsive care and build trust in communities that have historically been cut off from the healthcare system. Patients have cited the informal, respectful, friendly, and inclusive climate aboard mobile health clinics, which supports building trusting relationships with care providers. This in turn improves healthcare access and helps address social determinants of health by opening the door to referring patients to specialists, enrolling patients in assistance programs, and connecting those in need to other available resources within the community. Additionally, some mobile health clinic programs are structured to prepare and train a culturally responsive public health and nursing workforce.

Systemic Barriers to Equitable Care

Improving equitable healthcare access requires us to understand the mechanisms of structural racism in healthcare. These include: shortage of insurance coverage and affordable services, poor geographical access to medical services, lack of culturally responsive service delivery, and experiences of racism in services.

Many mobile health clinic programs successfully deliver culturally responsive care and build trust in communities.

Due to the underfunding of Medicaid programs, especially in the South, there are over a million people in the insurance coverage gap who are disproportionately Black, Hispanic, Asian American, American Indian/Alaskan Native, Native Hawaiian/Pacific Islanders, and of multiple races. Difficulty affording healthcare services affect both the uninsured and the insured and disproportionately impacts low- and middle-income workers, as well as Black and Hispanic people.

Communities that are racially and economically segregated are more likely to experience shortages of primary care and other medical services. For example, predominantly Black neighborhoods are not only more likely to have insufficient numbers of primary care physicians, but they also have fewer surgeons and limited access to outpatient facilities.

Lack of confidence or mistrust in the medical system is another significant contributor to health disparities. Medical mistrust is a response to racism embedded in healthcare structures and interpersonal racism experienced by many Black, Brown, and Indigenous people in healthcare settings.

Supportive policies and funding [for mobile health clinics] are still lacking.

The outcomes of healthcare injustices are significant and compound over time: inequitable access to quality healthcare services, delay of needed medical care, use of the emergency department as a primary source of care, and insufficient knowledge of available services in affected communities.

While broader antiracist policies are needed to support healthcare access in underresourced communities, mobile health clinics can help us gain some ground. However, they can only do so if they receive the financial support needed to make them an effective and sustainable tool for health equity.

Mobile Health Clinics Need More Financial Support

Though the case for mobile health clinics to address healthcare disparities and reduce costs has been established in the research, supportive policies and funding are still lacking. Many programs rely primarily on philanthropic funding sources, which can be unstable or unpredictable. The fee-for-service structure of insurance reimbursement is often inadequate to sustain programs. Federal grants are a large source of funding for mobile health clinics but may be time-limited or cover only the initial investment.

Funding structures on the federal, state, and organizational levels that enable the long-term sustainability of the programs are needed.

The federal government can facilitate the use of mobile health clinics within existing healthcare organizations through public insurance reimbursement incentives, such as specific value-based programs that incentivize the prevention of emergency department visits and hospitalizations, or increased reimbursement rates for specific prevention services that meet a high community need. And federal and state policymakers should take action to support expanding sustainable mobile clinic infrastructure.

State-level investment in these programs may also yield high returns. States can look to Maryland’s Wellmobile program as a model for serving communities’ primary care needs while training the nursing workforce. States can support mobile health clinics by reviewing and revising any unnecessary regulatory barriers to mobile clinic operations, and consider developing specific new regulations to increase the number and quality of mobile clinics in the state. States can also partner with local healthcare networks to create mobile health clinic programs to address regional needs.

Healthcare systems, managed care and accountable care organizations, and private payers stand to benefit from integrating mobile health clinics into current systems: to improve patient health outcomes, to prevent emergency department visits and hospital readmissions, and to enhance community relations and visibility.

Mobile health clinic programs nationwide are already improving access to healthcare; however, greater investment in mobile health clinic programs, sustainable funding structures, and integration into current health systems are urgently needed to expand the reach of this valuable model of service delivery to underresourced communities.