Julie Darnell, MHSA, AM The University of Chicago Free Clinics: Results from a Nationwide Survey

Acknowledgments Study Sponsors: Agency for Healthcare Research and Quality, U.S. Department of Health & Human Services Kaiser Commission on Medicaid and the Uninsured The California Endowment Society for Social Work and Research National Association of Social Workers Foundation Chicago Center of Excellence in Health Promotion Economics, The University of Chicago

Special Thanks National Association of Free Clinics State/regional free clinic associations Other “endorsing” organizations Individuals who have very generously taken the time to provide feedback on and/or fill out the survey! I couldn’t have done it without your help. THANK YOU!!

Study Population ALL private, nonprofit free clinics: Direct providers of medical, dental, mental health and/or pharmacy services Staffed by paid staff and/or volunteers Charge no fee or nominal fee Housed in permanent building or mobile unit Seek to serve mostly (or only) uninsured persons May or may not bill insurers

Study Population (continued) Excluded: Clinics that EXPECT payment: Bill patient Clinics that are directly supported by federal programs: Federally qualified health centers and “look-alikes” (FQHCs/FQHC-LAs) Rural health clinics (RHCs) Title X family planning providers

Survey Instrument 12-page mail survey developed with substantial input from > 50 free clinic experts and practitioners Pre-tested survey with 23 clinics representing all clinic types in 9 states Explored: Clinic operations Patients Services Staff & Volunteers Future plans

Sources Used to Develop Sampling Frame Member lists: National Association of Free Clinics Volunteers in Health Care All state/regional free clinic associations Directories: 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 Guidestar, a database of all IRS-recognized nonprofit org. Internet Survey State primary care associations Area Health Education Centers (AHECs) Medical schools State medical societies

Methods Contacts: 1. FedEx letter 2. Reminder postcard 3. /fax (if available) 4. Replacement survey 5. Letter with incentive 6. Phone call

Response Rate 1,188 surveys mailed 944 surveys returned 180 clinics (16%) determined ineligible 764 surveys returned from eligible clinics 1,000 eligible clinics 236 surveys not returned Overall response rate: 76%

Number of Free Clinics by State Note: Number of free clinics reflects clinics verified in 2004 – 2006.

Common Myths Dispelled Myth Free clinics are run only by volunteers “Real” doctors don’t work/volunteer at free clinics Free clinics are open 1 night/week Fact >75% of free clinics have some paid staff (66% have paid ED) At an average clinic, 95% of MDs are board- certified 50% of clinics are open 3+ days/week

Common Myths Dispelled Myth Free clinics aren’t a medical home Free clinics are temporary Free clinics are insignificant Fact 77% of free clinics provide repeated care to same patients Average age of all free clinics is 12 years (1994) 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 In U.S., 92% of clinics report having a Board Range from 2 to 83 members Mean = 13 Patient Representation on Board Note: Data is based on 735 clinics.

Operating Budget Note: Data is based on 587 clinics. a mean = $287,810 b median = $125,000 b a

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 yearsClinics founded since 2000 Note: Data is based on 751 clinics.Note: Data is based on 280 clinics. # of days open per week

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 Note: Data is based on 688 clinics. One-third of clinics report treating adults only. At an average clinic, the percentage of patients who are children, adults 18-64, or adults 65+.

Patients by Race/Ethnicity Note: Data is based on 696 clinics. 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.

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 Note: Data is based on 575 clinics. At an average clinic, the percentage of patients who are 200% FPL.

Patients by Insurance Status Note: Data is based on 752 clinics. 6% clinic report billing insurers

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 Notes: Data is based 415 clinics. Excludes clinics that do not utilize referral providers. At an average clinic, the number of referrals made yearly.

Concern about Malpractice Liability a Barrier to Volunteer Recruitment Note: Data is based on 702 clinics.

Board Certification of Physicians Note: Data is based on 590 medical clinics. At an average clinic, the percentage of physicians who are board-certified.

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 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 (w) (c)

Next Steps Disseminate results Distribute national free clinic directory Secure funding for second wave of survey – stay tuned!