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A Nationwide Survey

Julie S. Darnell, PhD, MHSA

Arch Intern Med. 2010;170(11):946-953.

Background  Since an increasing proportion of the US population is without health insurance, a network of free clinics has gradually developed to provide care for the uninsured. 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. As a result, policy discussions have been forestalled and potentially fruitful collaborations between free clinics and other safety net providers have been hindered. The objective of this study is to describe the attributes of free clinics and measure their contribution to the safety net.

Methods  National mail survey of all known free clinics in the United States. The main outcome measures were organizational structures, operations, revenue sources, patient profiles, services, and staffing.

Results  The study represents the first census of free clinics in 40 years and garnered a 75.9% response rate. Overall, 1007 free clinics operated in 49 states and the District of Columbia. Annually, these clinics provided care for 1.8 million individuals, accounting for 3.5 million medical and dental visits. The mean operating budget was $287 810. Overall, 58.7% received no government revenue. Clinics were open a mean of 18 hours per week and generally provided chronic disease management (73.2%), physical examinations (81.4%), urgent/acute care (62.3%), and medications (86.5%).

Conclusions  Free clinics operate largely outside of the safety net system. However, they have become an established and meaningful contributor to it. Policymakers should consider integrating the free clinic network with other safety net providers or providing direct financial support.

Author Affiliations: School of Social Service Administration, The University of Chicago, Chicago, Illinois. Dr Darnell is now with the Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago.

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