Demographics of Uninsured Adults Admitted for Preventable Hospitalizations in North Carolina Communities with a Free Clinic

Despite modest improvements in the number of preventable hospitalizations in recent years, rising health care costs have mitigated any reductions in costs incurred.  Total costs for preventable hospitalizations exceeded $30 billion in 2006.  Uninsured adults have increased rates of preventable hospitalizations given their limited access to healthcare.  Free clinics offer primary care services for uninsured individuals and could aid in reducing preventable hospitalizations.  North Carolina has so far rejected Medicaid expansion and is expected to have over 1 million uninsured residents. 

Using North Carolina hospital discharge data 2003 to 2007, we identified preventable hospitalizations using the Agency for Healthcare Research and Quality’s overall Preventive Quality Indicator. We compared the demographic characteristics (e.g., gender, race/ethnicity, age, zip code income quartile, and rural/urban location) of uninsured adults admitted for a preventable hospitalization in North Carolina based on whether or not they reside in a county with a free clinic.  We used chi-square analysis to assess the statistical significance of these differences.  Our results characterize uninsured groups at highest risk for preventable hospitalizations, and whether communities served by a free clinic experience fewer preventable hospitalizations. Our findings focus on an overlooked part of the health care safety net, and could support greater coordination and collaboration among hospitals, other healthcare organizations, and free clinics.