Barriers to Care: Assessing Reasons for Being Uninsured Among Free-Clinic Patients in Brooklyn

BACKGROUND: Health insurance is critical for access to health care. However, in Central Brooklyn, more than 1 in 3 adults are uninsured or went without health insurance in 2006. The Brooklyn Free Clinic is a student-run, physician-supervised clinic that serves the local uninsured population. This study aims to identify reasons for being uninsured among the free clinic patient population. METHODS: Patients 18 years or older were recruited during clinical hours from November 2009 to February 2010 to complete semi-structured interviews. Basic demographic information, including age, race/ethnicity, educational level, citizenship, and employment status, were collected. Open-ended questions assessed patients' reasons for being uninsured. Responses were categorized and common reasons for being uninsured were compiled. RESULTS: Thirty-nine participants were interviewed with a median age of 30 years. Sixty-four percent were female, 59% were African-American, and 61% were employed. Forty-one percent were born outside the United States and 40% completed college or above. The following reasons were cited for being uninsured: health insurance expenses are too high (42%), income level is too high to qualify for free health insurance (24%), unemployment (18%), and immigration status (12%). CONCLUSIONS: The predominant reasons reported for being uninsured are financial concerns. Current health reform efforts to expand health coverage should consider various reasons for being uninsured, including the need to make coverage more affordable. This is paramount as cost remains a significant barrier to obtaining primary and continuing healthcare even among those currently employed.