**Figure 2.**

*Map of FL with Mobile clinics in urban and rural locations.*

#### **Figure 3.**

*Map of NC with Mobile clinics in urban and rural locations.*

**Figure 4.** *Map of GA with Mobile clinics in urban location.*

**Figure 5.** *Map of TX with Mobile clinics in urban location.*

and 12 urban locations (**Figure 2**); North Carolina had three urban and one rural (**Figure 3**); Georgia and Texas had all clinics in urban locations, **Figure 4** and **Figure 5** respectively. Reasons provided by the mobile clinic representatives as to how they choose their respective locations varied across the different states and the types of healthcare delivery strata (dental, dental/preventive, preventive care, primary care/preventive, and mammography/primary care/preventive). Some of the reasons mentioned included using results from hotspot mapping, and community needs assessments [10].

## **4. Costs of operating Mobile clinic programs**

Planning a mobile clinic program requires several stakeholders in both the private and public sectors [11] therefore the costs and complexities of running mobile clinics should not be underestimated [12]. Costs include recurrent costs (variable costs of running the mobile clinic such as maintenance, repair, fuel, and compensation for the healthcare providers who provide services in the mobile clinics), as well as capital costs such as the acquisition costs of equipment, and vehicle [13]. Brazil, for example, has a sustainable 8-year mobile clinic program integrating the community, government, and private sectors [14] as a way to ensure the sustainability of the program. Mobile clinic outreach programs can be complex and expensive; however, these complexities can be mediated by public policy or resource planning [15]. Acquiring mobile clinics and delivering healthcare services is therefore an effort that needs careful planning and assessment, as well as consideration of outcomes and how performance would be evaluated [16].

A survey [10] based on the accounting documentation of the mobile clinics in each of the stratified service types: dental, dental/preventive, preventive care, primary care/preventive, and mammography/primary care/preventive was conducted. The findings highlighted in a recent publication [17] showed the highest averages of annual operating costs for dental and dental/preventive services ranging (\$2.3–\$2.5 million) and preventive and primary care/preventive between \$479,000 and \$822,000. Mammography/primary care/preventive had the lowest annual average of \$300,000. The largest overall cost line item was labor costs, followed by depreciation and then maintenance costs. Largest percentage of labor costs of more than 90% of total costs was in preventive and primary care/preventive. Dental and dental/preventive labor costs represented 80%, while mammography/primary care/

*Mobile Clinics in the United States and the COVID-19 Pandemic: A Response Strategy Model DOI: http://dx.doi.org/10.5772/intechopen.98692*

preventive had 65%. The highest percentage for depreciation costs was for mammography/primary care/preventive with (25%), followed by dental and dental/ preventive (13%), and preventive and primary care/preventive services at 5% [17]. The variation in depreciation costs was attributable to the differences in the type of capital equipment used by each of the stratified service types. For example, mammography's 25% likely corresponded to the expensive screening equipment. The percent of total costs attributable to maintenance was 10% for mammography/ primary care/preventive, followed by dental and dental/preventive with 7%, and preventive and primary care/preventive at 3% [17].

The estimated cost per patient visit was analyzed using the reported annual patient visits from survey responses. Average annual operating cost per patient visit ranged from \$243 in preventive services to \$65 for mammography/primary care/ preventive delivery services. While the cost per patient visit for dental services (\$123) was considerably lower than dental/preventive services (\$225), preventive services had an average cost per patient visit of \$243, suggesting an overall high cost for prevention programs [17].
