Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #116496

Kristie Long Foley, PhD¹, Heather Champion, PhD², Scott D. Rhodes, PhD, MPH, CHES³, Donna Kronner³, C. Randall Clinch, DO, MS⁴, Mark Wolfson, PhD⁵, and Alison Snow Jones, PhD¹. (1) Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, 336-716-9881, kfoley@wfubmc.edu, (2) Public Health Sciences/Social Sciences and Health Policy, Wake Forest University School of Medicine, 2000 West First Street, Piedmont Plaza II, 2nd Floor, Winston-Salem, NC 27104, (3) Department of Public Health Sciences, Wake Forest University Health Sciences, Section on Social Sciences and Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157-1063, (4) Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, (5) Department of Public Health Sciences, Wake Forest University School Medicine, 2000 West First Street, Piedmont Plaza II, Winston-Salem, NC 27104

Background: A variety of factors have led to an increase in the importance of free clinics as the ultimate safety net for people without health insurance. Increased financial pressures on hospitals and other providers have resulted in reductions in the amount of free healthcare they can provide. Recently, increased unemployment and rising insurance costs have resulted in reduced health insurance coverage. Methods: This study evaluated contextual factors associated with the presence of free clinics using county-level Census data from North Carolina (n=100). Results: Bivariate analyses revealed that counties with a higher proportion of people in poverty, Medicaid eligibles, unemployed, or uninsured, and living in a rural area were less likely to have a free clinic. Counties with a lower population-to-physician ratio, a higher proportion of hospital beds, and presence of an academic medical center were more likely to have a free clinic. Counties with a rural health center were less likely to have a free clinic. In a multivariate model, population-to-physician ratio (OR .99, p=.04) and unemployment rate (OR .49 p=.02) remained statistically significant. The proportion of a population living in a rural region approached statistical significance (OR .94, p=.07). The presence of an academic medical center perfectly predicted the presence of a free clinic. Conclusions: These findings suggest that excess health care resources may be the driving force behind the presence of a free clinic. Implications for community health planning and policy needed to provide care for the uninsured are presented.

Learning Objectives: At the conclusion of this session, the audience will

• have a better understanding of community factors that affect access to care among the uninsured
• understand the importance of a community needs assessment when developing and implementing free clinic services
• recognize the value of contextual data in health care planning

Keywords: Access to Care, Community Health Planning

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.