Download Free Clinics:

Free Clinics:
Results from a Nationwide Survey
Julie Darnell, MHSA, AM
The University of Chicago
Acknowledgments
y Study Sponsors:
Agency for Healthcare Research and Quality,
U.S. Department of Health & Human Services
y Kaiser Commission on Medicaid and the Uninsured
y The California Endowment
y Society for Social Work and Research
y National Association of Social Workers Foundation
y Chicago Center of Excellence in Health Promotion Economics,
The University of Chicago
y
Special Thanks
National Association of Free Clinics
y State/regional free clinic associations
y Other “endorsing” organizations
y Individuals who have very generously taken the time to provide
feedback on and/or fill out the survey!
y
I couldn’t have done it without your help.
THANK YOU!!
Study Population
y ALL private, nonprofit free clinics:
Direct providers of medical, dental, mental health and/or
pharmacy services
y Staffed by paid staff and/or volunteers
y Charge no fee or nominal fee
y Housed in permanent building or mobile unit
y Seek to serve mostly (or only) uninsured persons
y May or may not bill insurers
y
Study Population (continued)
y Excluded:
y
Clinics that EXPECT payment:
y Bill patient
y
Clinics that are directly supported by federal programs:
y Federally qualified health centers and “look-alikes” (FQHCs/FQHC-LAs)
y Rural health clinics (RHCs)
y Title X family planning providers
Survey Instrument
y 12-page mail survey
developed with substantial
input from > 50 free clinic
experts and practitioners
y Pre-tested survey with 23
clinics representing all clinic
types in 9 states
y Explored:
y Clinic operations
y Patients
y Services
y Staff & Volunteers
y Future plans
Sources Used to Develop
Sampling Frame
y Member lists:
y
y
y
National Association of Free Clinics
Volunteers in Health Care
All state/regional free clinic associations
y Directories:
y
y
y
y
Free Clinic Foundation of America
Medical/Dental Ministry: A Directory of North American sites
Compiled by M. Hiller for congressional study
Medical Student-Run Clinics of America
Sources Used to Develop
Sampling Frame
y Guidestar, a database of all IRS-recognized nonprofit org.
y Internet
y Survey
y State primary care associations
y Area Health Education Centers (AHECs)
y Medical schools
y State medical societies
Methods
y Contacts:
1. FedEx letter
y 2. Reminder postcard
y 3. Email/fax (if available)
y 4. Replacement survey
y 5. Letter with incentive
y 6. Phone call
y
Response Rate
y 1,188 surveys mailed
944 surveys returned
y 180 clinics (16%) determined ineligible
y 764 surveys returned from eligible clinics
y
y 1,000 eligible clinics
236 surveys not returned
y Overall response rate: 76%
y
Number of Free Clinics by State
Note: Number of free clinics reflects clinics verified in 2004 – 2006.
Common Myths Dispelled
y Myth
y Free clinics are run only by
volunteers
y Fact
y >75% of free clinics
have some paid staff
(66% have paid ED)
y
“Real” doctors don’t
work/volunteer at free
clinics
y
At an average clinic,
95% of MDs are boardcertified
y
Free clinics are open 1
night/week
y
50% of clinics are open
3+ days/week
Common Myths Dispelled
y Myth
y Free clinics aren’t a
medical home
y Fact
y 77% of free clinics
provide repeated care
to same patients
y
Free clinics are temporary
y
Average age of all free
clinics is 12 years (1994)
y
Free clinics are
insignificant
y
Free clinics serve, on
average, 1.9 million
mostly uninsured
patients annually
Clinic Characteristics
Top Reasons for Clinic Founding
Note: Data is based on 757 clinics.
Who Founded Clinic
Note: Data is based on 757 clinics.
Organizations & Groups that
Helped to Establish Free Clinic
Note: Data is based on 757 clinics.
Types of Clinics
Note: Data is based on 764 clinics.
Number of Sites
Among clinics with > 1 site,
mean # of sites = 4.
Note: Data is based on 741 clinics.
Clinic Affiliation
Note: Data is based on 756 clinics .
Type of Organizational Affiliation
among Clinics with an Affiliation
Notes: The number of clinics that reported an affiliation is 338. Data is based on 323 clinics.
Percentages exceed 100% because clinics reported more than one type of clinic affiliation.
Religious Affiliation
Note: Data is based on 752 clinics.
Medical Student-Run
Note: Data is based on 718 clinics.
Governance
y In U.S., 92% of clinics
report having a Board
Range from 2 to 83
members
y Mean = 13
y
Note: Data is based on 735 clinics.
Patient Representation
on Board
Operating Budget
a mean = $287,810
b median = $125,000
b
a
Note: Data is based on 587 clinics .
Top Sources of Funding
Note: Data is based on 748 clinics .
Percentage of Revenues from
Government Sources
Note: Data is based on 728 clinics.
Year of Founding
Note: Data is based on 756 clinics.
Number of Days Open per Week
Clinics founded in ALL years
Clinics founded since 2000
# of days open per week
Note: Data is based on 751 clinics.
Note: Data is based on 280 clinics .
Regular Process for Tracking
Medical Errors and Patient Safety
Note: Data is based on 702 medical clinics.
Patients
Patients by Sex
Note: Data is based on 653 clinics.
Patients by Age Group
At an average clinic, the percentage of patients who
are children, adults 18-64, or adults 65+.
Note: Data is based on 688 clinics. One-third of clinics report treating adults only.
Patients by Race/Ethnicity
At an average clinic, the percentage of patients who
are Hispanic or Latino, White, Black or African
American, Asian, American Indian or Alaska Native,
or Native Hawaiian or Pacific Islander.
Note: Data is based on 696 clinics.
Special Populations
Note: Data is based on 750 clinics.
Residency Eligibility Requirements
Note: Data is based on 757 clinics.
Income Eligibility Requirements
Note: Data is based on 750 clinics.
Maximum Income as a Percent of
Poverty among Clinics with Income Test
Notes: 424 clinics reported that they require patients to meet an income test.
Data is based on 400 clinics.
Patients by Income
At an average clinic, the percentage of
patients who are <100% FPL, between
100-200% FPL, and > 200% FPL.
Note: Data is based on 575 clinics.
Patients by Insurance Status
6% clinic report billing insurers
Note: Data is based on 752 clinics.
Patient Appointments
Notes: Data is based on 745 clinics. Categories are not mutually exclusive.
Relationship with Patients
Note: Data is based on 739 clinics. Percentages may exceed 100 due to rounding.
Average # of Patients
per Clinic per Year
Notes: Data is based on 533 clinics.
402,150 (median) 785,400 (mean) total new patients served yearly (n=1,050).
1.0 million (median) 1.9 million (mean) total unduplicated patients served yearly (n=1,050).
Average Number of Patient Visits
per Clinic per Year
Notes: Data is based on 589 medical clinics and 200 dental clinics .
1.6 million (median) 3.2 million (mean) total medical visits at clinics in the U.S. (n=998).
105,141 (median) 286,275 (mean) total dental visits at clinics in the U.S. (n=347).
Patient Medical Visits
per Patient per Year
Note: Data is based on 415 clinics.
Services
Availability of Primary Care Services
Notes: Data is based on 727 clinics. Percentages exceed 100% because clinics
reported more than one option for the availability of service.
Availability of Reproductive Health
Services
Notes: Data is based on 727 clinics. Percentages exceed 100% because
clinics reported more than one option for the availability of service.
Availability of Services for
Selected Conditions
Notes: Data is based on 727 clinics. Percentages exceed 100% because
clinics reported more than one option for the availability of service.
Availability of Other Services
Notes: Data is based on 727 clinics. Percentages exceed 100% because
clinics reported more than one option for the availability of service.
No Fees/Donations by
Type of Service
Note: Data is based on 727 clinics that provide medical services, 264 clinics that provide
dental services and 669 clinics that provide medications.
Cost to Patient for
Diagnostic Services
Note: Data is based on 703 clinics.
On-Site Pharmaceutical Facilities
Note: Data is based on 671 clinics.
Arrangements to Provide Medications
Note: Data is based on 660 clinics.
Staff and Volunteers
Paid Staff
Notes: Data is based on 743 clinics. Assumes responses with missing values = 0.
Medical Staff and Volunteers
Notes: The number of clinics on which data is based varies by category. Percentages
exceed 100% because clinics reported staff and volunteers in more than one category.
Dental Staff and Volunteers
Notes: The number of clinics on which data is based varies by category. Percentages exceed
100% because clinics reported more than one option for the availability of service.
Other Professional Staff and
Volunteers
Notes: The number of clinics on which data is based varies by category. Percentages exceed
100% because clinics reported more than one option for the availability of service.
Administrative Staff and
Volunteers
Notes: The number of clinics on which data is based varies by category. Percentages exceed
100% because clinics reported more than one option for the availability of service.
Referrals to Providers
At an average clinic, the number
of referrals made yearly.
Notes: Data is based 415 clinics . Excludes clinics that do not utilize referral providers.
Concern about Malpractice Liability a
Barrier to Volunteer Recruitment
Note: Data is based on 702 clinics.
Board Certification of Physicians
At an average clinic, the percentage of
physicians who are board-certified.
Note: Data is based on 590 medical clinics.
Clinical Training or Supervision
of Students
Note: Data is based on 716 medical clinics, 254 dental clinics, and 719 medical and other clinics.
Future Plans
Concrete Plans to Add
Paid Staff w/in Next 1-3 Years
Note: Data is based on 656 clinics in the nation.
Concrete Plans to Add Any Services
w/in Next 1-3 Years
Note: Data is based on 764 clinics.
Subgroups of Clinics
Mean Number of Hours Open
per Week
Note: The number of clinics on which data is based varies by category.
Mean Operating Budget
Note: The number of clinics on which data is based varies by category.
Mean Number of Unduplicated
Patients
Note: The number of clinics on which data is based varies by category.
Mean Number of Patient Visits
Note: The number of clinics on which data is based varies by category.
Mean Number of Services
Note: The number of clinics on which data is based varies by category.
Further Information
Contact Information
y Julie Darnell, MHSA, AM
Division of Health Policy & Administration
School of Public Health
University of Illinois at Chicago
1603 W. Taylor Street, Room 754
Chicago, IL 60612
312-996-2712 (w) 773-263-0533 (c)
[email protected]
Next Steps
y Disseminate results
y Distribute national free clinic directory
y Secure funding for second wave of survey – stay tuned!