julie darnell, mhsa, am the university of chicago free clinics: results from a nationwide survey

Julie Darnell, MHSA, AMThe University of Chicago

Free Clinics:Results from a Nationwide Survey

AcknowledgmentsStudy Sponsors:

Agency for Healthcare Research and Quality, U.S. Department of Health & Human ServicesKaiser Commission on Medicaid and the

UninsuredThe California EndowmentSociety for Social Work and ResearchNational Association of Social Workers

FoundationChicago Center of Excellence in Health

Promotion Economics, The University of Chicago

Special ThanksNational Association of Free Clinics State/regional free clinic associationsOther “endorsing” organizationsIndividuals 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 PopulationALL private, nonprofit free clinics:

Direct providers of medical, dental, mental health and/or pharmacy services

Staffed by paid staff and/or volunteersCharge no fee or nominal feeHoused in permanent building or mobile unitSeek to serve mostly (or only) uninsured

personsMay 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 Instrument12-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 operationsPatientsServicesStaff & VolunteersFuture plans

Sources Used to Develop Sampling FrameMember lists:

National Association of Free ClinicsVolunteers in Health CareAll state/regional free clinic associations

Directories:Free Clinic Foundation of AmericaMedical/Dental Ministry: A Directory of North

American sitesCompiled by M. Hiller for congressional studyMedical Student-Run Clinics of America

Sources Used to Develop Sampling FrameGuidestar, a database of all IRS-recognized

nonprofit org.InternetSurveyState primary care associationsArea Health Education Centers (AHECs)Medical schoolsState medical societies

MethodsContacts:

1. FedEx letter2. Reminder postcard3. Email/fax (if available)4. Replacement survey5. Letter with incentive6. Phone call

Response Rate1,188 surveys mailed

944 surveys returned180 clinics (16%) determined ineligible764 surveys returned from eligible clinics

1,000 eligible clinics236 surveys not returnedOverall response rate: 76%

Number of Free Clinics by State

Note: Number of free clinics reflects clinics verified in 2004 – 2006.

Common Myths DispelledMyth

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 DispelledMyth

Free clinics aren’t a medical home

Free clinics are temporary

Free clinics are insignificant

Fact77% 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 Affiliationamong 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.

GovernanceIn U.S., 92% of

clinics report having a BoardRange from 2 to 83

membersMean = 13

Patient Representation on Board

Note: Data is based on 735 clinics.

Operating Budget

Note: Data is based on 587 clinics .

a mean = $287,810b median = $125,000

ba

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 WeekClinics founded in ALL years

Clinics 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 <100% FPL, between 100-200% FPL, and > 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 forSelected 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 andVolunteers

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 andVolunteers

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 aBarrier 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 InformationJulie 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) jdarnell@uic.edu

Next StepsDisseminate resultsDistribute national free clinic directorySecure funding for second wave of survey –

stay tuned!