What is the role of free clinics in the safety net?

• Published in: Medical care Vol. 49; no. 11; p. 978
• Main Author: Darnell, Julie
• Format: Journal Article
• Language: English
• Published: United States 01.11.2011
• Subjects: African Americans - statistics & numerical data; Ambulatory Care Facilities - statistics & numerical data; Cross-Sectional Studies; Health Services Accessibility - statistics & numerical data; Health Services Needs and Demand - statistics & numerical data; Humans; Medicaid - statistics & numerical data; Medically Uninsured - statistics & numerical data; Poverty - statistics & numerical data; Uncompensated Care - statistics & numerical data; United States; Urban Population - statistics & numerical data; United States
• ISSN: 1537-1948
• DOI: 10.1097/MLR.0b013e3182358e6d

Free clinics play an important role in the safety net but little is known about what factors drive their existence within a given community. The anecdotal literature suggests that they exist due to growing numbers of uninsured and a lack of affordable care. To determine whether unmet needs explain the existence of free clinics. The relationship between demographics, Medicaid policy, and ambulatory safety-net care on the geographical distribution of all known free clinics (n=1007) across all metropolitan statistical areas (n=361) in the United States is investigated cross sectionally. Drawing from numerous secondary data sources and an original dataset of all known free clinics, a negative binomial model is used to examine whether free clinic prevalence is higher in communities with larger proportions of uninsured patients, poor adults, and African Americans and is lower in communities with greater availability of federally qualified health centers (FQHCs), FQHC look-alikes, and health departments, and more generous Medicaid eligibility for working parents and Medicaid beneficiary/provider payment levels. None of the demographic variables has a positive, statistically significant relationship to the number of free clinics in a metropolitan statistical area. However, the number of FQHC grantees per 10,000 uninsured individuals [incidence rate ratios (IRR)=0.69, P<0.05], the number of FQHC look-alike sites per 10,000 uninsured individuals (IRR=0.46, P<0.05), Medicaid beneficiary payments (IRR=0.9998, P<0.05), and Medicaid eligibility levels (IRR=0.998, P<0.10) are negatively associated with the number of free clinics. Thus, free clinics seem to respond to particular gaps left by safety-net providers and Medicaid but do not seem to respond to direct need.