Mobile health clinics in the United States

Clinic services, cost, and client demographic data were exported from Mobile Health Map website into Microsoft Excel. Aggregate client demographic information from the online impact and quality tools were uploaded to Qualtrics [15] and subsequently exported into Microsoft Excel. The estimated proportions across all clinics were derived from an unweighted mean of the estimate measurements provided by each individual clinic. For example, if clinic A reported that they served an estimated 50% Asian clients and clinic B estimated an average of 30% Asian clients, the reported average per clinic would be 40% Asian clients. This approach was used because the goal of the analysis was to provide averages across clinics with the clinic being the unit of observation, rather than summarizing data at the individual level. While the use of a weighted average was considered to give greater weight to clinics with higher volume, this type of analysis was not possible because only 168 of the clinics provided total patient volume. The number of clinics reporting on each variable differed and is depicted in the text, figured, and tables.

Though 33% of the 286 reporting clinics were independent programs, mobile clinics are often part of a larger organization. The most common of these affiliations were with hospital systems in 29% and universities in 24%. Nineteen percent (19%) reported to be affiliated with health centers, 17% with insurance companies, and 12% with faith-based organizations (Fig. 2).

Of the 173 mobile clinics reporting on total annual cost, the average cost per mobile clinic operation was $632,369. Of the 58 clinics designating themselves as a prevention clinic (excluding primary care), the average cost was $319,868. Of the 58 primary care clinics reporting cost, the average was $981,092. The average cost of the 37 dental clinics reporting was $1,169,559.

To cover these costs, mobile health clinics depend heavily on philanthropy and government funding. Of the 281 clinics reporting on their sources, 52% reported philanthropic support and 45% reported federal funding (Fig. 3). Health insurance companies also provide much of the funding: 38% reported revenue from public insurance providers and 37% from private insurance providers. Thirty-two percent of clinics reported client payments as a source of revenue.

A variable number of clinics reported on each data element. Of the 253 mobile clinics that reported information on the number of visits, the median number of annual visits was 3491 with an interquartile range (IQR) of 1828 to 6050. One hundred sixty-six clinics also reported the number of new visitors annually, of which the median was 1200 new visits with an IQR of 574 to 2123.166 clinics also reported the average number of new visitors annually, of which the average was 2713. One hundred ninty-two clinics reported gender distribution. Female clients make up a slight majority with each mobile clinic serving an average of 55% female clients and 44% male clients. A category for transgender people was recently added.

Of the 183 clinics that reported on age, the average percentage of clients between 0 and 17 years of age was 41%, and the average percentage falling between 18 and 44 years was 20% per clinic (Table 1). The average percentage of clients 45–64 years of age was 31% per clinic, and the lowest utilization is found in the age group 65+ with an average 11% per clinic.

One hundred eighty-six clinics provided data on the race/ethnicity of clients. The average percentage of white clients was 42%, Black/African-American clients was 35%, and Hispanic clinics was 27% (Table 1). The average percentage of Asians, Native American, multiracial, and those clients designating their ethnicity as “other” were less than 5%.

Many mobile clinics aim to reach populations with limited access to care. To understand which client populations the clinics were designed to serve, clinics are asked to report the group or groups they target. Of the 291 clinics reporting, 56% targeted the uninsured, 55% low-income groups, 38% homeless persons, and 36% rural communities (Fig. 4).

Of the 146 clinics that provided information on insurance status of clients, the average percentage of uninsured clients was approximately 41%. The average percent of clients covered by Medicaid/CHIP was 30% per clinic and by Medicare was 15% per clinic. The average reported percentage of clients with private insurance was 25% per clinic, some of whom also have coverage with public insurance.

Mobile clinics have the option to report on the type of services they offer. Of the 724 clinics that provided information on service type, 47% reported that they provide prevention services exclusively, 41% reported to be primary care focused, and 28% reported to provide dental care (Fig. 5). Mammography, pediatric, mental health, asthma, maternal and infant health, disaster relief, vision, and other specialty services are also provided by mobile clinics.

Of the 67 clinics reporting on specific services/screenings provided, 31% provided screening for hypertension, 31% provided diabetes screenings and treatment (or referral to treatment), 28% provided diet counseling, and 27% provided cholesterol screenings. The mobile clinics also offer screening for colorectal (13%), cervical (13%) and breast cancer (19%) and osteoporosis (9%). There are also services for hearing (6%), vision (13%), depression (25%), and obesity (25%). Clinics describe discussion of daily aspirin use (13%), calcium supplementation (12%), and folic acid use for women of childbearing age (13%). Smoking cessation advice (25%) and alcohol screening and brief counseling for alcohol use (25%) are also provided on some clinics.

Mobile clinics operate in all 50 states, the District of Columbia, and Puerto Rico (Table 2). Many are located in areas of high population density in major cities around the country such as Atlanta, Boston, Chicago, Dallas, Denver, Houston, Los Angeles, New York, Orlando, Phoenix, San Francisco, San Jose, Seattle, and St. Louis (Fig. 6). There are also clinics located in less populated areas.