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Chapter 8. Free Clinics Helping to Patch the Safety Net
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Chapter 8 Free Clinics Helping to Patch the Safety Net Stephanie Geller Buck M. Taylor H. Denman Scott Volunteer-based clinics, sometimes called free clinics, have existed in the United States for decades. These clinics, which provide free or low-cost care to uninsured and underinsured patients, depend largely on the philanthropic community for financial support and operate largely through the efforts of volunteer physicians and other health care providers. Care at many volunteer-based clinics is completely free of charge, while other clinics request a nominal fee or operate on a sliding-scale fee structure based on the patient’s income. Some free clinics exist under the umbrella of churches, health departments, or hospitals, while others are independently governed nonprofit agencies. The common thread binding free clinics together is their dependence on volunteers . A small clinic might operate with a handful of physicians who come together one evening a week to see patients in borrowed space. Some larger clinics have a volunteer base of hundreds of clinicians, including physicians, nurses, and dentists, and provide care several days and evenings a week. Most free clinics provide some care at the clinic and arrange for their patients to receive additional services, such as laboratory, radiology, and specialty care off site for free or reduced rates. A number of articles have been published describing how individual clinics operate,– but little has been published on the impact of free clinics as a group or how they contribute to the nation’s safety net. The first account of a survey of free clinics was published more than 30 years ago. In 1970, the University of California Health Services Research Program conducted a survey of free clinics through a grant from what was then the National Center for Health Services Research and Development, Health Services and Mental Health Administration. This survey, designed to identify and describe all known free clinics in the United States and Canada, identified 59 clinics that had opened between 1967 and 1969. A large number of the clinics identified were in California, where the project was housed, but clinics in 19 other states, Stephanie Geller, EdM, is a policy analyst at Rhode Island Kids Count. Buck M. Taylor, MPH, is the chief operating officer at Community Health Partners in Bozeman, Montana. H. Denman Scott, MD, MPH, is professor emeritus of medicine and heath services, policy, and practice and dean of the faculty at Brown University. 78 Geller, Taylor, and Scott the District of Columbia, and Canada also were identified. The authors noted that by 1971, when the paper was published, there were more clinics (as many as 135) in North America. Since that time, there have been a few articles published describing how free clinics operate or the role they play in the larger safety net,, but no published accounts of large-scale surveys. A few organizations have conducted informal surveys in order to create directories of free clinics,, and some state and regional free clinic associations produce directories of their member clinics. This chapter describes a survey of volunteer-based clinics in seven midwestern states, conducted through a cooperative effort of Volunteers in Health Care, a national resource center funded by the Robert Wood Johnson Foundation to support programs serving the uninsured, and the Free Clinics of the Great Lakes Region (FCGLR), an association of free clinics in the Midwest. The FCGLR was started by free clinic directors from Illinois, Indiana, Iowa, Michigan, and Ohio who sought to formalize the grassroots networks of free clinics in the Midwest. Since its early development in 1996, the network has grown to include clinics in seven states: Illinois , Indiana, Iowa, Michigan, Minnesota, Ohio, and Wisconsin. The data were compiled to chronicle the efforts of these mostly private, independent clinics and to make more visible the role that free clinics play within the larger safety net. The clinics that participated in the survey represent only a small fraction of the clinics operating across the country. Nonetheless, these findings may help to focus attention on the number of uninsured being cared for by volunteer-based clinics and offer a glimpse of how these clinics operate and how they fit into the larger safety net. Methods In 1999, the Free Clinics of the Great Lakes Region (FCGLR), in partnership with Volunteers in Health Care, conducted a mail survey of the FCGLR member clinics . The survey was conducted to learn more about the member clinics, increase the visibility of volunteer-based clinics and the patients they serve...