Findings from a survey of free clinics suggest that an estimated 1.8 million individuals make approximately 3.5 million medical and dental visits to free clinics annually, according to a report in the June 14 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
"Our nation's 46 million uninsured often delay or forgo needed health care because the cost is prohibitive," the author writes as background information in the article. Uninsured patients pay an average of more than $50 per physician visit. Traditional sources of primary care, including public clinics and federally qualified health centers, charge fees and bill patients. "Aside from cost considerations, care is frequently difficult to find, especially for those with the least resources."
"On the margins of the formal health care safety net for uninsured people, free clinics serve to partly offset these costs and access problems," writes Julie S. Darnell, Ph.D., M.H.S.A., then of the University of Chicago and now of the School of Public Health, University of Illinois at Chicago. Dr. Darnell conducted a national mail survey of all known free clinics in the United States between October 2005 and December 2006. Free clinics were defined as non-profit organizations that provided some type of medical or dental services directly to patients for no fee or a nominal fee of up to $20. The clinics did not bill patients or deny services for lack of payment, and were not recognized as federal health centers or family planning clinics.
The survey response rate was 75.9 percent. At the time of the survey, 1,007 free clinics operated in 49 states and the District of Columbia, providing care for an estimated 1.8 million individuals annually. Among the 764 clinics that reported complete survey information, organizational structures varied; most were independent entities, some operated in rented buildings and a few owned their buildings. The facilities were open for an average of 18 hours per week. They generally provided chronic disease management (73.2 percent), physical examinations (81.4 percent), urgent or acute care (62.3 percent) and medications (86.5 percent).
Free clinics reported serving an average of 747 new patients per year and 1,796 total unduplicated patients. Patients had a variety of attributes that impeded their access to primary care: lack of insurance, inability to pay, limited English proficiency, a minority racial or ethnic background and lack of housing.
The clinics' average operating budget was $287,810, with funding received from diverse sources, including charitable donations (90.6 percent), civic groups (66.8 percent), churches (66.3 percent), foundations (65.1 percent) and corporations (55.1 percent). A total of 58.7 percent received no government revenue.
"Free clinics provide a range of preventive and general medical care for an estimated 10 percent of the working-age adult uninsured population who seek care," Dr. Darnell concludes. "Free clinics have passed the point in history when they can exist below the radar. At the same time, policymakers and other safety net providers must acknowledge the important role that free clinics play. Formal integration of free clinics into the safety net has the potential to strengthen the overall health system, which is important regardless of the outcomes of the national health reform debate."
(Arch Intern Med. 2010;170:946-953. Available pre-embargo to the media at www.jamamedia.org.)
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Archives of Internal Medicine