Free Clinics: Local Responses to Health Care Needs

Foreword

Foreword With ever-rising health care costs, access to health services has become a national priority. The increasing expense has a dampening effect on the growth of the U.S. economy, and inadequate health care access hinders the productivity and efficiency of the labor pool. With the growing burden of the uninsured, U.S. health care is facing another crisis. Like a strong ballast against the storm, free and charity clinics provide an ambulatory safeguard to the millions who would otherwise fall victim to this economic torrent. The lay public and the government have recognized the importance of quality health care for the public good. With the passage of the Patient Protection and Affordable Act in 2010, the first steps to eliminating the insurance barriers to health care access have been taken. Perhaps the United States will move to a system designed not to maximize profits but to broaden the basic health care available to the largest possible segment of society. Until the act is fully implemented and the challenge of finding access to quality health care is no longer an issue, however, free clinics will still be needed to care for the economically disadvantaged. In 2011, 46.3 million people were uninsured in the United States, about 15% of the population. This figure was expected to rise by the end of 2012. For minorities , the figures are worse, with nearly 30% of Hispanics and nearly 20% of African Americans being uninsured. Free clinics receive nearly 4 million patient visits a year.,  Without these clinics, the nation’s emergency departments and public health clinics (including federally qualified community health centers) would have to absorb all these patients and the costs associated with their care. The more than 1,200 free and charitable clinics nationwide play a crucial role in public health., These clinics do so in the face of mounting pressures from both the for-profit sector and governmental forces. Both federal and state budgets are being trimmed, and funds to provide limited reimbursement to keep community health centers and free clinics afloat are being cut. Despite these threats, the services these clinics provide must continue, and this book explains why. Each chapter demonstrates some of the many reasons that free clinics are important to the overall health system, including descriptions of the strategies these safety-net clinics have developed to continue providing service in this challenging economic climate. Free clinics stand on one of the transcendent pillars of medicine—doing good. This essential principle of benevolence drives societies’ best and brightest to pursue careers in medicine, buttresses them through the rigorous education and training process, and sustains them until their matriculation. Although the promise of financial prosperity is attractive, generations of health professionals realize that a fulfilled career in medicine often pays dividends in nonmonetary ways. This cohort of health professionals is driven by purpose rather than profit. Out of these individuals’ ideals and the obligation of the profession to serve the common good, free clinics were born and continue to thrive. x Foreword The second part of this book highlights the work done at various student-run free clinics. The student-run free clinic phenomenon traces its beginnings to the free clinic movement initiated by David Smith when he founded the Haight Ashbury Free Clinics in 1967 (see Weiss’s history of the movement). The concept of a free clinic was taken up by medical students, spreading across the country during the seventies and eighties. The academic medical establishment soon realized the value that student-run free clinics provided their enrollees and began to support them. These clinics provided a tremendous opportunity to instill the core values of compassion and commitment to helping the underserved that is crucial to the development of future physicians. Almost 50 medical schools operate about 110 student-run free clinics, which primarily treat underserved and uninsured populations . The Association of American Medical Colleges through its Group on Student Affairs has issued guidelines to help its members support students providing patient care abroad that are relevant for free clinic care by students as well. Student-run free clinics also speak to a larger problem that has echoed through U.S. health care since the first Haight Ashbury clinic opened. It is generally accepted that health is a right, not a privilege, and that the provision of public health services is a public good, yet it is still not required that everyone have the same access to basic primary health care. The public still becomes...