Dec 30, 2017

Have Van Will Travel

On a sunny Thursday afternoon, I pulled into the parking lot at Encina High School in Sacramento, California, to meet Anna Darzins the manager of the Health on Wheels (HOW) Van. A small group of mothers and their children sat at folding chairs and tables outside filling out clinic forms.

A 5-year old boy was being weighed by a medical assistant inside the compact, but surprisingly well-equipped van, run by Elica Health Centers. The van has two exam rooms, equipped to examine people of any age, a reception area and a nursing station. Reminds me of the model apartment at my local IKEA store that amazingly packs in everything a small family could need - including a bicycle, a baby crib, as well as the kitchen sink - into a compact 200-square feet.

The Health on Wheels Van started about four years ago in collaboration with the San Juan Unified School District in Sacramento. The mobile clinic visits several school campuses within its service area and offers primary care, preventive care, vaccinations, sports physicals, and other clinical services to uninsured students at schools for free four days a week during the school year.

Since its inception, the van has scaled up its services to provide street medicine to Sacramento’s homeless population, preventative screening at health fairs, medical care at refugee centers, and pre-employment physical exams to young adults at local community colleges. The van has a close relationship with law enforcement, and police officers can bring people in need to the van for health care services. The van has a veterinary program that brings care to animals at homeless encampments. Local nursing and physician assistant training programs use the van as a community-based clinical training site.

Effective strategies to improve population health extend care beyond the four walls of brick-and-mortar clinics and hospitals. Increasing access through mobile clinics reduces unnecessary emergency department use and helps vulnerable populations manage chronic conditions such as high blood pressure and asthma.

Mobile clinics run by health systems enhance their outreach efforts, increase their visibility in the community, and serve as a source of referral to brick-and-mortar clinics and hospitals.

Operating costs for a mobile health clinic are estimated at about $500,000 for the first year, factoring in the cost of the vehicle, and approximately $250,000 annually thereafter. Despite these expenses, mobile clinics provide effective and cost-effective care, primarily due to reductions in avoidable hospital and emergency department visits. For instance, The Family Van, a mobile health clinic that provides medical care to the poor in Boston, has a return on investment of $36 for every $1 invested.

Are there any downsides to mobile clinics? If they provide only sporadic care instead of facilitating continuity of care, they serve as temporary solutions to a more pervasive access problem. This potential drawback can  be mitigated by strong connections to community resources and local clinics that can provide additional resources to their patients.

There are approximately 1500 mobile clinics in the United States. These clinics get 5 million visits patient visits each year. Mobile clinics are quite literally, an alternative vehicle to bring health care to the under-insured and uninsured, and to people who have trouble accessing healthcare due to health status, language barriers, homelessness, lack of transportation, or their geographic location.

- Ulfat Shaikh

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