Free Clinics Fill Gaps in Health Safety Net, Survey Finds
[Writer] This is Research News from U-I-C, the University of Illinois at Chicago.
Today, Julie Darnell, assistant professor in the School of Public Health, talks about a survey she conducted of free clinics in the United States which found out they provide care to about 1.8 million mostly uninsured patients annually.
Here is Professor Darnell:
[Darnell] I recently completed a study of all known free clinics in the United States. This study represents the first census of free clinics since the 1960s. I’ve discovered through this study that there 1,007 free clinics operating across the United States, in every state but Alaska. Combined, free clinics provide care to 1.8 million uninsured people and provide 3.1 million medical visits every year.
A chief aim of my study was to carve a niche of free clinics to distinguish them from other kinds of safety net providers. Free clinics target care to the uninsured. They directly provide health care services, mostly medical and to a large extent also dental, but a distinguishing characteristic of free clinics is that their care, as their name suggests, is free. Their service is not contingent on payment. When I considered what do they look like, I discovered that they’re open on average about 18 hours a week. They operate on very small operating budgets. Their mean budget is $287,000 but their median budget is $125,000. What does that mean? That half of all free clinics have budgets of below $125,000 a year. They receive money mostly from non-governmental sources—individual donations, corporate donations, United Way, foundations.
Another defining characteristic of free clinics is that there really is no average free clinic. It’s a very heterogeneous population. 30% of them are open only five or few hours per week while 25% are open full time, 40 or more hours per week. Many have operating hours during the day time but also during the evening and weekends so that means that they are providing access to care, perhaps, when other alternative primary care providers are not open.
Who are they serving? Free clinic patients are half white but they disproportionately serve members of racial and ethnic minority groups. Most of them are female. They’re adults between 18 to 64 and they’re low-income. They target populations who do not qualify for other kinds of public insurance, under Medicare and Medicaid. They’re providing a fairly basic set of services which include importantly, medications, physical exams, health education, chronic disease management, urgent and acute care. Free clinics have really organized themselves to be gap fillers so they’re providing services that are not routinely available elsewhere.
Of note, although most of their free clinic patients are women, fewer than half report providing gynecological care. Free clinics are providing services mostly by using volunteer clinicians. The volunteer providers include physicians, nurses and other mid-levels. There are certain classes of professionals who are underrepresented, such as psychologists and social workers. But while free clinics rely heavily on volunteers, three-quarters of them have some kind of paid staff, often in a leadership role as an Executive Director.
Is there a role for free clinics after health reform? Absolutely. We still face perhaps as many as 23 million uninsured people and anticipate that some populations will face problems in accessing care given the expected shortages in the physician workforce. We have to remember that free clinics are gap fillers and they provide services that are not routinely available and to people who have trouble accessing care. Free clinics are not temporary. Many own the buildings in which they operate, have paid staff, have budgets that exceed $750,000 and serve thousands of patients annually, so there’s no suggestion that those free clinics would disappear. And we know that some free clinic users currently have insurance and so you could infer that they have other choices for care but they choose to seek care from a free clinic.
We have much to gain from incorporating free clinics more formally into our safety net. Two things need to happen: free clinics need to come out of the closet, and they’re used to operating below the radar, and at the same time, policy makers and other safety net providers need to acknowledge the very vital role that free clinics play in our safety net.
[Writer] Julie Darnell is an assistant professor in health policy and administration.
For more information about this research, go to www-dot-news-dot- uic-dot-edu … click on “news releases” … and look for the release dated June 14, 2010.
This has been research news from U-I-C – the University of Illinois at Chicago.
