Darnell Julie S
School of Social Service Administration, The University of Chicago, Chicago, Illinois 60612, USA.
Arch Intern Med. 2010 Jun 14;170(11):946-53. doi: 10.1001/archinternmed.2010.107.
Since an increasing proportion of the US population is without health insurance, a network of free clinics has gradually developed to provide care for the uninsured. Despite widespread concern about the uninsured and the viability of the safety net, free clinics have been overlooked and poorly studied, leaving old assumptions and beliefs largely unchallenged. As a result, policy discussions have been forestalled and potentially fruitful collaborations between free clinics and other safety net providers have been hindered. The objective of this study is to describe the attributes of free clinics and measure their contribution to the safety net.
National mail survey of all known free clinics in the United States. The main outcome measures were organizational structures, operations, revenue sources, patient profiles, services, and staffing.
The study represents the first census of free clinics in 40 years and garnered a 75.9% response rate. Overall, 1007 free clinics operated in 49 states and the District of Columbia. Annually, these clinics provided care for 1.8 million individuals, accounting for 3.5 million medical and dental visits. The mean operating budget was $287,810. Overall, 58.7% received no government revenue. Clinics were open a mean of 18 hours per week and generally provided chronic disease management (73.2%), physical examinations (81.4%), urgent/acute care (62.3%), and medications (86.5%).
Free clinics operate largely outside of the safety net system. However, they have become an established and meaningful contributor to it. Policymakers should consider integrating the free clinic network with other safety net providers or providing direct financial support.
由于美国未参保人口比例不断上升，一个免费诊所网络逐渐发展起来，为未参保者提供医疗服务。尽管人们普遍关注未参保者以及安全网的可行性，但免费诊所一直被忽视且研究不足，旧有的假设和观念基本未受到质疑。结果，政策讨论被推迟，免费诊所与其他安全网提供者之间潜在的富有成效的合作也受到阻碍。本研究的目的是描述免费诊所的特征，并衡量它们对安全网的贡献。
对美国所有已知的免费诊所进行全国性邮件调查。主要结局指标包括组织结构、运营情况、收入来源、患者概况、服务内容和人员配备。
该研究是40年来对免费诊所的首次普查，回应率为75.9%。总体而言，49个州和哥伦比亚特区共有1007家免费诊所。这些诊所每年为180万人提供医疗服务，进行了350万次医疗和牙科诊疗。平均运营预算为287,810美元。总体而言，58.7%的诊所没有政府收入。诊所平均每周开放18小时，通常提供慢性病管理（73.2%）、体检（81.4%）、紧急/急性护理（62.3%）和药物治疗（86.5%）。
免费诊所大多在安全网系统之外运营。然而，它们已成为安全网的既定且有意义的贡献者。政策制定者应考虑将免费诊所网络与其他安全网提供者整合，或提供直接财政支持。
