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Chapter 10 Characteristics of Patients at Three Free Clinics Rachel Mott-Keis Linda Gifford DeGeus Suzanne Cashman Judith Savageau First seen in the 1960s,, free clinics were established to provide medical care for individuals, particularly those who were underinsured or uninsured, and were unable to obtain needed care elsewhere. Free clinics are part of an extensive patchwork safety net system that attempts to care for financially disenfranchised people. According to the Free Clinic Foundation of America, a free clinic, which by definition does not charge for its services, is a private, community-based health care clinic for families of the working poor and the retired. In 2000, the Free Clinic Foundation of America listed over 300 registered free clinics nationwide; the actual number is far higher because many free clinics are not registered. According to Volunteers in Health Care, a national resource center supporting programs that serve the uninsured, in 2004, more than 1,000 free clinics were functioning in the United States. Because there is no organized body tracking or monitoring free clinics, it is difficult to determine the precise number of free clinics operating in any particular state or region. As more free clinics are developed and an increasing number of patients rely on these sites for care,, the need to understand who uses the clinics, why they are used, and whether patients view them as an addition to another usual source of care or as their only source of care, becomes more compelling. Answers to questions such as these can help community, state, and national planning bodies make informed decisions about resource allocation and ensure that safety net providers are able to cope with demands placed on their resources. This assumes deeper importance as increasing strains are placed on health care safety net facilities. Although articles on free clinics appear in the literature,– many of the issues related to who uses them and why have not been addressed. This chapter helps to fill Rachel Mott-Keis, MD, is a clinical instructor of family medicine at Boston University School of Medicine. Linda Gifford DeGeus, MD, is a pediatrician at Thundermist Health Center, in Woonsocket , Rhode Island. Suzanne Cashman, ScD, is a professor and the director of community health in the Department of Family Medicine and Community Health at University of Massachusetts Medical School (UMMS), Worcester. Judith Savageau, MPH, is an associate professor in the Department of Family Medicine and Community Health, UMMS. Characteristics of Patients at Three Free Clinics 107 that gap by reporting on a comprehensive patient survey conducted at three free clinics in central Massachusetts. Methods During a seven-week interval, between January 24 and March 12, 2001, a descriptive study of patients using any of the then three free clinics in Worcester, Massachusetts , for medical or dental care was conducted. For almost a decade, students from the University of Massachusetts Medical School, also located in Worcester, had been working in each of these clinics. The clinics were chosen as study sites because of the authors’ (RMK and LGD) work there. Additionally, given that this city of 175,000 people is also the site of a major tertiary care teaching hospital and two federally funded community health centers, there was significant administrative and provider interest in learning more about the free clinic patient population . We were interested particularly in why people felt the need to use free clinics when what should be accessible forms of medical care for individuals, regardless of insurance or socioeconomic status, exist in the city. The free clinics in this study do not turn away any patients, nor do they request information related to a patient’s immigration status. The presence of the other safety net providers has not affected the clinics’ view of whom they should serve. Based on the beliefs of their founders, patients with and without insurance, as well as patients known to have care elsewhere, were seen at each of the clinics. The clinics are not formally connected but do share the philosophy that all patients desiring care should receive it. The clinics share a friendly, cooperative relationship with one another as well as with the other major local safety net providers. Many of the free clinic physician volunteers are on staff at the Worcester hospital and teach at the medical school. In addition, free clinic staff members routinely refer patients to the community health centers for care that will be comprehensive and continuous. A detailed profile of each of the participating clinics appears in this chapter’s...

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