Transcript Is There A (Volunteer) Doctor in the House? The Role of Free Clinics

Is There A (Volunteer) Doctor
in the House?
The Role of Free Clinics and
Volunteer Referral Networks in
Serving the Uninsured
Stephen Isaacs, J.D., and Paul Jellinek, Ph.D.
Isaacs/Jellinek
December 2007
The Need to Provide Medical Care to the
Uninsured and the Poor has Risen
Dramatically


Between 2000 and 2005, more than 17 million
Americans lost their health insurance or signed up
for Medicaid
More than one in four Americans—88 million
people— is now either uninsured or covered by
Medicaid
Private Physicians are the Principal
Source of Primary Care for Uninsured
and Medicaid Patients
Private Physicians
Other
Other
20%
Private
Physicians
80%
Even as the Need is Growing, the
Proportion of U.S. Physicians Providing
Charity Care Has Been Declining
100
90
80
70
60
50
40
30
20
10
0
1996-1997 2004-2005
Two Options that Can Make it Easier
For Doctors To Volunteer

Free clinics

Volunteer referral networks
Free Clinics

Started in 1960’s

More than 1,700 currently operating

Serve more than 2.5 million people

Doctors go to the clinic to provide services
Volunteer Referral Networks

Started in 1990s

More than 50 currently in operation

Doctors provide services in their offices
How These Programs Make It Easier
For Doctors to Volunteer

Screen for eligibility

Distribute the burden of care equitably

Work with PAPs and other sources to assure access to
prescription meds

Coordinate access to labs, specialty care, hospitalization

Minimize no-shows
Kellogg Project on Volunteer Health Care
(Completed in 2006)

Literature review

Expert interviews


Meetings with national, regional, and state
associations
Site visits to 21 free clinics and volunteer referral
networks
Volunteer Programs Visited
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Asheville, NC
Chicago, IL
Charleston, WV
Cleveland, OH
Coldwater, MI
Cotati, CA
Exeter, NH
Grand Rapids, MI
Hilton Head, SC
Kalamazoo, MI
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Knoxville, TN
Maryville, TN
Miami, FL
Omaha, NE
Racine, WI
Red Bank, NJ
San Francisco, CA
Sevierville, TN
Venice, CA
Wichita, KS
We found great variation in:

Size of program

Staffing

Services

Sources of support
Although Each Program is Unique, They
Have Many Features in Common

Local roots

High patient volume

Primarily serve uninsured patients

High proportion of immigrant patients

Constant financial challenges
External Challenges

Growing demand

Increasing burden of chronic care

Increasing economic strain on providers

Changing patient mix
Service-Related Challenges

Access to specialty care

Access to medications

Malpractice coverage
Organizational Challenges



Hand-to-mouth existence
Lack of contact with similar programs in other
communities
Burnout
The Bottom Line

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
Since private physicians provide four-fifths of the care to
uninsured and poor people, the recent decline in the number
of physicians willing to do this, combined with the growing
number of uninsured, poses a threat to the nation’s safety-net
services.
Free clinics and referral networks can make it easier for
doctors to volunteer. Their experience to date illustrates the
potential of volunteerism and also its limitations.
Given the sheer numbers of uninsured and poor people—25%
of the U.S. population is either uninsured or receives
Medicaid—the reach of volunteer programs (and, indeed, the
reach of all institutions providing safety-net services) is
limited, requiring a national solution.