Efficient frontiers in a frontier state: Viability of mobile dentistry services in rural areas

摘要

This study investigates the implications of adding mobile dentistry services to a community health center (CHC) in a rural area. CHCs are not-for-profit healthcare organizations which provide comprehensive primary care services to patients in the US, primarily for under-served and uninsured populations. We estimate the demand for the service in a five-county region in southwestern Montana, USA and work with stakeholders to determine a set of potential service locations. A mixed-integer optimization model is formulated to determine the frequency of stops in each location over a finite (six month) planning horizon with the goal of improving accessibility and availability of dental services while maintaining financial sustainability of the CHC. The financial considerations and social impact of offering a mobile dentistry service in southwestern Montana are assessed. Computational results based on a case study demonstrate the challenges facing mobile dentistry operations to increase access to under-served populations in a financially viable manner. Hybrid solutions, in which care is offered at a mix of fixed locations and mobile locations, appear to best balance the objectives of financial sustainability and expanded access to care. (C) 2017 Elsevier B.V. All rights reserved.