Moving Healthcare Towards Increased Accessibility

By: Anwesa Brahmachary, Human Biology, Health, and Society ‘26

The number of people with chronic illnesses in the United States is projected to increase by 99.5% from 2020 to 2050. With this astounding growth rate, the need for consistent health monitoring is also projected to increase [1]. However, geographical obstacles often prevent this access to healthcare, and as a result, off-site clinical facilities are becoming increasingly common. From furthering access to healthcare services for certain communities to reducing healthcare costs, off-site facilities are becoming progressively impressive.

Access to healthcare has been shown to vary geographically, based on socioeconomic, racial, and other variable statuses of communities. According to a study done across a 15-year time period, more socioeconomically disadvantaged areas are likely to lose facilities over time. Furthermore, areas with residents of minority groups are more likely to have less healthcare facilities [2]. For rural communities specifically, patients often have to travel several hours to reach clinics, leading to lower levels of vaccinations, hospital referrals, and other treatments [3]. Over time, these disparities in access to healthcare can lead to worse health outcomes for communities, especially from a preventative aspect.

As of March 28th, 2017, New York officially began allowing hospitals to provide off-site primary care services in order to allow continuation of care for patients with geographical barriers [4]. These off-site programs are continuing to increase in number as they continually yield benefits such as increasing medical services. For instance, the Family Van program from Harvard Medical School has been able to prevent emergency visits and increase primary care availability [5]. Furthermore, access to maternal healthcare has particularly risen from off-site clinics. Maternity care deserts are areas with barriers to maternal care access and importance to reduce to make pregnancies safer for women. At the University of Texas Medical Branch at Galveston, an off-side clinic provided high-level ultrasounds and consultation of Medicaid-eligible women. Often local hospitals deny women because of their insurance status. With the off-site clinics, women don’t just receive services and check-ups they cannot otherwise access; they are also made aware of a location where they can deliver when rejected by local hospitals. In terms of the University of Texas off-site clinic, women were made aware that they could deliver at the University of Texas hospital even if it was farther away, despite being denied by their local hospital [6]. 

In addition, financial difficulties are reduced by these off-site clinic vans for both the patients and clinics that provide the facilities. To begin with how the clinics themselves are benefitted, the Family Van used in Boston showed $36 of investment return per dollar invested [7]. Operational costs are also saved for the clinic. For low-income patients who live in healthcare deserts, their cost of traveling is rapidly diminished by being able to attend an off-site clinic closer to them. Furthermore, a study was done showing that costs are also reduced via decreases in emergency room visits, hospital readmissions, and symptom-free days. The Family Van data showed that 1.4 million dollars were saved within an approximately two-year period. In addition, through data concerning Mobile Health Clinics, $71,714,286 in Quality-Adjusted Life Years (QALY) were saved. Quality-Adjusted Life Year is often a metric used by economists to evaluate the value of one year of a person’s life based on health care [8]. 

As disparities in healthcare access persist, off-site health clinics provide hope in reducing these inequities and increasing access to healthcare. These clinics have been shown to benefit both associated facilities and patients and will hopefully continue to grow and assist an increased number of people.

References: 

1. Ansah, J. P., & Chiu, C.-T. (2023). Projecting the chronic disease burden among the adult population in the United States using a multi-state population model. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.1082183 

2. Tsui, J., Hirsch, J. A., Bayer, F. J., Quinn, J. W., Cahill, J., Siscovick, D., & Lovasi, G. S. (2020). Patterns in geographic access to health care facilities across neighborhoods in the United States based on data from the National Establishment Time-series between 2000 and 2014. JAMA Network Open, 3(5). https://doi.org/10.1001/jamanetworkopen.2020.5105 

3. Evans, M. V., Andréambeloson, T., Randriamihaja, M., Ihantamalala, F., Cordier, L., Cowley, G., Finnegan, K., Hanitriniaina, F., Miller, A. C., Ralantomalala, L. M., Randriamahasoa, A., Razafinjato, B., Razanahanitriniaina, E., Rakotonanahary, R. J., Andriamiandra, I. J., Bonds, M. H., & Garchitorena, A. (2022). Geographic Barriers to Care Persist at the Community Healthcare Level: Evidence from Rural Madagascar. https://doi.org/10.1101/2022.08.16.22278862 

4. MLMIC Insurance Company. (2021, May 25). New law allows New York clinics to provide off-site Primary Care. https://www.mlmic.com/blog/physicians/new-york-law-permits-off-site-primary-care 

5. Yu, S. W., Hill, C., Ricks, M. L., Bennet, J., & Oriol, N. E. (2017). The scope and impact of mobile health clinics in the United States: A literature review. International Journal for Equity in Health, 16(1). https://doi.org/10.1186/s12939-017-0671-2 

6. Anderson, G. D., Nelson-Becker, C., Hannigan, E. V., Berenson, A. B., & Hankins, G. D. (2005). A patient-centered health care delivery system by a university obstetrics and Gynecology Department. Obstetrics & Gynecology, 105(1), 205–210. https://doi.org/10.1097/01.aog.0000146288.28195.27 

7. Li, W. Z.-M. (n.d.). Advancing Health Equity and value-based care: A mobile approach. Advancing Health Equity and Value-Based Care: A Mobile Approach. https://info.primarycare.hms.harvard.edu/perspectives/articles/mobile-clinics-in-the-us-health-system#:~:text=Mobile%20clinics%20are%20also%20an,disease%2C%20and%20pursue%20healthier%20living. 

8. Nguyen, O. K., Makam, A. N., & Halm, E. A. (2016). National use of safety-net clinics for primary care among adults with non-medicaid insurance in the United States. PLOS ONE, 11(3). https://doi.org/10.1371/journal.pone.0151610