Free clinic


A free clinic or walk in clinic is a health care facility in the United States offering services to economically disadvantaged individuals for free or at a nominal cost. The need for such a clinic arises in societies where there is no universal healthcare, and therefore a social safety net has arisen in its place. Core staff members may hold full-time paid positions, however, most of the staff a patient will encounter are volunteers drawn from the local medical community.
Free clinics are non-profit facilities, funded by government or private donors, that provide primary care, preventive healthcare, and additional health services to the medically underserved. Many free clinics are made possible through the service of volunteers, the donation of goods, and community support, because many free clinics receive little government funding.
Regardless of health insurance coverage, all individuals can receive health services from free clinics. However, said services are intended for persons with limited incomes, no health insurance, and/or who do not qualify for Medicaid and Medicare. Also included are underinsured individuals; meaning those who have only limited medical coverage, or who have insurance, but their policies include high medical deductibles that they are unable to afford. To offset costs, some clinics charge a nominal fee to those whose income is deemed sufficient to pay a fee. Clinics often use the term "underinsured" to describe the working poor.
Most free clinics provide treatment for routine illness or injuries; and long-term chronic conditions such as high blood pressure, diabetes, asthma and high cholesterol. Many also provide a limited range of medical testing, prescription drug assistance, women's health care, and dental care. Free clinics do not function as emergency care providers, and most do not handle employment related injuries. Few, if any, free clinics offer care for chronic pain as that would require them to dispense narcotics. For a free clinic such care is almost always cost-prohibitive. Handling narcotics requires a high level of physical security for the staff and building along with more paperwork and government regulation compared to what other prescription medications require.

History

At the turn of the century, healthcare in the United States became privatized despite many efforts by President Roosevelt and others to establish national health insurance, causing the healthcare system to neglect the lower classes. Starting in the 1950s, there have been incremental reforms to offset healthcare market failures and to better deliver healthcare services to low-income and underserved populations, including Medicaid and Medicare. Since then, there have still been increasing inequality and issues in coverage, access, cost, and quality of healthcare in America. In the United States, free clinics are a way to address this inequality and lack of universal healthcare, and as part of a health safety net.
The modern concept of a free clinic originated in 1950 in Detroit and was named the St. Frances Cabrini Clinic. However, the first documented free clinic is considered to be the Haight Ashbury Free Medical Clinic in California which was started by Dr. David Smith in 1967. These clinics coined the phrase, "health care is a right not a privilege" and they served vulnerable veteran populations after the Vietnam war, many of whom struggled with drug abuse. The Haight Ashbury Free Clinic revolutionized the practice of handling substance abuse issues by holding national conferences and working directly with the Food and Drug Administration and other government agencies to create comprehensive policies and to destigmatize mental health conditions related to drug abuse. From there free clinics spread to other California cities and then across the United States, such as the Berkeley Free Clinic. Many free clinics were originally started in the 1960s and 1970s to provide drug treatments. Each one offered a unique set of services, reflecting the particular needs and resources of the local community. Some were established to provide medical services in the inner cities, while others opened in the suburbs and many student-run free clinics have emerged that serve the underserved as well as provide a medical training site for students in the health professions. From 1968 through the 1970s, the Black Panther Party established several Peoples’ Free Medical Clinics as part of their efforts to counter systemic discrimination against Black people in hospitals and private medical practices. The Peoples' Free Medical Clinics served as an advocating body as well. These clinics helped integrate the sector of health care into political and social spheres within the United States. Their efforts played a key role in social reform in health care that ultimately led to the passage of the Medicare and Medicaid act of 1965.
In 2001 the National Association of Free and Charitable Clinics was founded in Washington, D.C. to advocate for the issues and concerns of free and charitable clinics. Free clinics are defined by the NAFC as "safety-net health care organizations that utilize a volunteer/staff model to provide a range of medical, dental, pharmacy, vision and/or behavioral health services to economically disadvantaged individuals. Such clinics are 5013 tax-exempt organizations, or operate as a program component or affiliate of a 501 organization." In time various state and regional organizations where formed including the Free Clinics of the Great Lakes Region, Texas Association of Charitable Clinic, North Carolina Association of Free Clinics, Ohio Association of Free Clinics and the Virginia Association of Free and Charitable Clinics. In 2005 Empowering Community Healthcare Outreach was established to assist churches and other community organizations start and run free and charitable clinics.
In 2010, the Patient Protection and Affordable Care Act was passed as a reform that aimed to make healthcare insurance more accessible to low and middle-class families. Specifically, it subsidized low-income populations’ purchase of individual coverage. It also incentivized employers to provide coverage to low-income employees, and made it mandatory for states to expand Medicaid to include non-disabled and young people with incomes that were below 138% of the federal poverty line. Studies show the ACA has been successful in redressing inequality in the access to healthcare. In 2015, there was a “4.2 percentage point increase in full-year insurance for the poor and 5.3 point increase for the near-poor”.
However, the implementation of the ACA proved to be more challenging as some states chose not to enforce it. Additionally, the ACA does not support undocumented immigrants, which means that health care outside of the free clinic to those who are undocumented remain relatively inaccessible. The ACA also does not reach homeless populations. Barriers include this population's low healthcare literacy, the requirements of residency verification, their difficulty accessing/applying for social services, their access to transportation, and the fact that many healthcare facilities do not accept Medicaid. It is not yet clear if and how the Trump administration will influence healthcare reform, specifically the access to healthcare for the most vulnerable. Trump often speaks out against the ACA; some scholars worry that President Trump's 2017 executive order, which eliminated cost-sharing reductions in the ACA, will result in an overall decrease in the number of people who can access affordable healthcare, thus emphasizing the need for free clinics.

Patient demographics

Of the 41 million uninsured people in the United States, the 355 officially registered free clinics in the country are only able to provide services to about 650,000 of them. On average, free clinics have annual budgets of $458,028 and have 5,989 annual patient visits. In another survey of three free clinics, 82% of patients reported that they began using a free clinics because they have are uninsured, and 59% were referred by friends/family. A similar study found that 65% were unemployed with students making up 17%. There also seems to be little correlation between education or employment status and insurance coverage in free clinic patients.
Age Group%
0-180.6
18-4429.4
45-6467.1
65+3.2

Free clinic patients are mainly low-income, uninsured, female, immigrants, or minorities. About 75% of free clinic patients are between the ages of 18 and 64 years old. According to another study, 70% of all patients 20 years and older make less than US$10,000 a year.
Income%
≤ $10,40052.9
$10,400 - $41,60045.6
≥ $41,6001.5

In a 1992-1997 survey of the Charlottesville Free Clinic, the patient body consists largely of a low income working class that reflects the demographics of the Charlottesville area. Most of the patients reported that without the free clinic, they would either seek the emergency room or do nothing at all if they got sick. There has been a shift over the years from patients seeking urgent care to patients seeking treatment for chronic illnesses. Combined, these factors suggest that free clinics will require additional resources in order to meet the rising demands of their patient population.
In a study of the Miami Rescue Mission Clinic in Florida, the most common conditions were mental health, circulatory system, and musculoskeletal system disorder. The most common of the mental health disorders were depressive disorders and anxiety disorders. Throughout multiple studies about patient demographics in metropolitan settings, there was a higher than national average prevalence of mental health disorder, obesity, diabetes, and smoking in free clinic patients.
System% in patients
Circulatory14.7
Respiratory 6.15
Respiratory 4.49
Gastrointestinal7.21
Genitourinary5.44
Endocrine6.26
Musculoskeletal13.9
Nervous6.15
Renal0.12
Eye3.54
Skin6.74
Teeth2.84
Mental health19.3