Feasibility Study: Implementation of On-Site Medical Services at MetroLink Stations

The Bi-State Development Research Institute has completed a feasibility study, supported and funded by the Missouri Foundation for Health, to examine the practicality of establishing health clinics at or near MetroLink Stations, testing the theory that the use of existing public transit stations will improve access to routine, non-emergency health care for residents, particularly those who are transit-dependent or live in close proximity to MetroLink stations, MetroBus routes or Metro Call-A-Ride paratransit service. The Research Institute finds both a significant need for accessible health care services in targeted areas of North St. Louis County, and opportunities for providers to address those needs through the use of mobile health clinics.

While the research looked at high poverty rates and concentrations of transit-dependent individuals in both North St. Louis County and in North St. Louis City, the study primarily focused on areas served by the MetroLink light rail system in North St. Louis County, given that the areas around the stations are far more residential than those surrounding the stations in the City of St. Louis. The study indicated North St. Louis County is home to a large number of households who do not lease or own any vehicles, including many communities along MetroLink where 15 to 45 percent of households lack access to a vehicle. In several areas, up to 70 percent of households were found to have no access to a vehicle. In addition, the study identified a lack of health care facilities along MetroLink in North St. Louis County or even within a half-mile of a light rail station.

In 2011, the St. Louis County Department of Public Health found that emergency department utilization and hospitalization in North St. Louis County was 56.7 percent higher than in the rest of St. Louis County. The top 10 diagnoses for these residents accounted for 40 percent of total visits, and most related to conditions better served in a non-emergency setting or that could have been avoided entirely with appropriate preventative care. Yet, many public transit-dependent populations simply did not have access to non-emergency health care services in the St. Louis region, according to the St. Louis County Department of Public Health.

After researching the potential for three different types of clinics — permanent structure, modular building and mobile clinic — the feasibility study found mobile clinics to have substantially lower annual costs of $82,900, compared to $193,545 for a modular building and just over $210,000 for a permanent structure.

The mobile unit offered the most flexibility, with the ability to be deployed to several locations in the priority areas identified. Mobile clinics remove logistical barriers, such as transportation issues, long wait times and financial obstacles related to health insurance requirements and co-payments. Research also indicated mobile health clinics can provide a significant return on investment (ROI) – a national estimate of $14 ROI per $1 invested in a mobile clinic.

The study showed mobile clinics are particularly successful in reaching populations with poorer health and less access to health care than the general population. While a mobile clinic may be less costly and more convenient than modular or permanent buildings, the findings demonstrated there are some services it cannot offer, such as dispensing prescriptions or offering X-rays. A permanent building or a modular version could offer a wider array of services down the line, but the study determined those options did not warrant further study at this time, due to the high cost and logistical challenges.

Based on input from health care professionals in the region and additional demographic information gathered as part of the study, priority stations for a mobile clinic along the MetroLink system would include the North Hanley, Rock Road and Wellston MetroLink Stations. The North County Transit Center in Ferguson was also identified as a potential mobile clinic location, and the Riverview Transit Center in North St. Louis City warranted further consideration.