Free Clinics in the United States Serve Millions Each Year

Emma Hitt, PhD

June 15, 2010

June 15, 2010 — Free clinics treat an average of 1.8 million people in the United States each year and represent an important part of the healthcare "safety net" system, according to the findings of a new survey.

Julie S. Darnell, PhD, MHSA, formerly from the University of Chicago and now with the School of Public Health, University of Illinois at Chicago, reported the findings in the June 14 issue of the Archives of Internal Medicine.

"Despite widespread concern about the uninsured and the viability of the safety net, free clinics have been overlooked and poorly studied, leaving old assumptions and beliefs largely unchallenged," the author notes.

Dr. Darnell mailed a survey to all known free clinics in the United States. For the purposes of the survey, free clinics were defined as nonprofit organizations that provided medical or dental services directly to patients for no fee or a nominal fee of up to $20. The clinics did not deny services for lack of payment and were not considered federal health centers or family planning clinics.

Three fourths of the 1007 free clinics in 49 states and the District of Columbia responded to the survey.

On average, each clinic reported serving 747 new patients each year and 1796 total unduplicated patients. Approximately 3.5 million medical and dental visits were made to free clinics annually. Factors that impeded access to primary care services were lack of insurance, inability to pay, lack of proficiency in English, a minority racial or ethnic background, and lack of housing.

The clinics were open for 18 hours per week on average and typically provided chronic disease management (73.2%), physical examinations (81.4%), urgent or acute care (62.3%), and medications (86.5%). Organizational structures varied, but most were independent entities. Some were located in rented buildings, and a few owned their buildings.

The clinics' average operating budget was $287,810. A total of 58.7% received no government funding. Funding was most often through charitable donations (90.6%), civic groups (66.8%), churches (66.3%), foundations (65.1%), and corporations (55.1%).

According to Dr. Darnell, 46 million people are uninsured and often delay or forgo needed healthcare, and this number is growing. Free clinics provide a range of preventive and general medical care for an estimated 10% of the working-age adult uninsured population who seek care.

"Formal integration of free clinics into the safety net has the potential to strengthen the overall health system, which is important regardless of the outcome of the national health reform debate," the author concludes.

In an accompanying editorial, Patricia D. Gibbs, MD, and Richard H. Gibbs, MD, from the San Francisco Free Clinic and Department of Family and Community Medicine, University of California–San Francisco, remark that, "With a national plan to expand health insurance passed by Congress and signed by President Barack Obama, some may mistakenly think that free clinics will no longer be needed. " They agree with Dr. Darnell's assessment that, with expanded insurance coverage, many free clinics will be integrated into the funding and billing network, but others will remain the safety net. Dr. Gibbs and Dr. Gibbs go on to explain that, "it is clear that the health care expansion will not cover all of the uninsured and will take several years to put into practice. Free clinics will be there to catch those who fall through these gaps."

The study was supported by a grant from the Agency for Healthcare Research and Quality, the Kaiser Commission on Medicaid and the Uninsured, and the California Endowment California Endowment and fellowships awarded by the Society for Social Work and Research, the National Association of Social Workers, and the Chicago Center of Excellence in Health Promotion Economics at the University of Chicago. The author and the editorialists have disclosed no relevant financial relationships.

Arch Intern Med. 2010;170:946-953.

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