Free clinics: Findings from a nationwide survey

Given our widespread attention to the rising number of uninsured persons and continued concern about the viability of the healthcare safety net, free clinics should be considered because they serve uninsured persons who are at greatest risk for adverse health outcomes. This research reports on the first nationwide comprehensive study of free clinics, and it describes the characteristics and distribution of the clinics in the United States. A national mail survey (October 2005 – December 2006) of all known free clinics in the United States was completed, using a 70-item, 12-page questionnaire designed to obtain information about the attributes of free clinics, the characteristics of patients, the amount of scope of services, and the number and type of staff and volunteers. Of 1,038 clinics that were determined eligible, 789 responded, yielding a response rate of 76%. Free clinics are private nonprofit organizations providing healthcare services to uninsured individuals at no charge or for a nominal fee. They are staffed principally by volunteer licensed healthcare professionals but also utilize paid staff. Having consulted more than three dozen sources to generate my sampling frame, I estimate that there are approximately 1,050 free clinics in the United States. Free clinics exist in every state, although the number varies considerably from one clinic (Alaska, Delaware, Hawaii, and Rhode Island) to 71 clinics (Texas). The number of free clinics per 100,000 residents ranges from .07 clinics (New Jersey) to 1.64 clinics (Vermont). Free clinics are open 18 hours (mean) per week. Most provide some primary medical services on site, including medications (92%), physical exams (87%), health education (78%), chronic disease management (73%), and urgent care (67%). The total mean number of medical and dental visits per clinic per year is 3,489 with a mean operating budget of $290,790. Most free clinics (58%) report that they receive no revenues from government sources. While 50% of free clinic patients are white, minorities are represented disproportionately; African Americans account for 21% and Latinos account for 25%. Free clinics have existed for several decades and a few for nearly a century; the mean age is 12 years. Free clinics serve 1.9 million (mean) patients annually. Free clinics are important contributors to the healthcare safety net. Operating with little or no government funding, free clinics target their resources to uninsured patients. The very existence of free clinics suggests the limits of a safetynet buttressed by insurance and government.