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Free Clinics

Free clinics are community-based entities that provide healthcare services mostly to uninsured people at little or no cost to their patients. Free clinics are organized as private, nonprofit organizations (or programmatic components of nonprofit organizations). They are run by volunteer, licensed healthcare professionals who deliver basic medical services, but the clinics often have a small paid staff to support their volunteer infrastructure. Free clinics tend to be located in permanent stand-alone facilities or mobile units or housed in borrowed or rented spaces, such as church basements or homeless shelters. They may be independent entities or part of or affiliated with another nonprofit organization (e.g., church, hospital, or social service agency). Free clinics also are supported mostly by private sources of funding.

History

The American Medical Association (AMA) shunned the free-clinic movement of the 1960s, the era when the number of free clinics grew rapidly. Since 1994, however, official AMA policy has supported free clinics. Free clinics are now a preferred model that private physicians adopt to provide care for the growing numbers of uninsured and underserved individuals. In the mid-1990s, the Robert Wood Johnson Foundation (RWJF) funded 40 projects through a $12 million initiative to encourage private physicians to improve access to care for the uninsured and underinsured. Under this RWJF grant program, physicians in nearly one of every three projects chose a free-clinic model as a method to improve access to healthcare. Free clinics may have emerged initially to treat “outsiders” (e.g., drug addicts and runaway youth), as exemplified by the Haight Ashbury Free Clinics in San Francisco, a free medical clinic situated at the epicenter of the 1960s hippie movement, founded to serve patient populations who identified with the counterculture. However, many free clinics now serve less marginalized segments of the population, such as low-income individuals who cannot afford health insurance, and underinsured patients. Many free clinics today target their services to the so-called working poor. Thus, in the past 40-plus years, free clinics have redefined “needy” to include the medically indigent or underserved, a much broader spectrum of patients than in the past.

Over the years, the number of free clinics in the nation has grown exponentially, from 59 in the 1960s to more than 1,000 in the 2000s. However, their precise number is unknown. Free clinics are found in every state except Alaska. The number of free clinics in the states varies widely, from 1 free clinic each in Delaware, Hawaii, and Rhode Island to more than 70 free clinics in North Carolina.

Research

Despite their long history and broad geographic distribution, free clinics have received little attention from health services researchers, largely due to a dearth of publicly available data and a lack of consensus about what constitutes a free clinic. Notably, the national Institute of Medicine's (IOM) seminal study on the nation's safety net America's Health Care Safety Net: Endangered but Intact (2000) does not even mention free clinics. Consequently, there is very little understanding about the roles that free clinics play in the nation's ambulatory healthcare safety net.

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