Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA.
Med Care. 2011 Nov;49(11):978-84. 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.
免费诊所在美国安全网中扮演着重要角色，但对于其在特定社区存在的原因知之甚少。从轶事文学中可以看出，它们的存在是由于未参保人数的增加和负担得起的医疗保健的缺乏。
确定未满足的需求是否可以解释免费诊所的存在。
本研究通过横断面研究，调查了美国所有大都市统计区（n=361）中所有已知的 1007 家免费诊所的地理位置分布与人口统计学、医疗补助政策和门诊安全网护理之间的关系。本研究利用来自众多二手资料来源和所有已知免费诊所的原始数据集，采用负二项回归模型来检验免费诊所的流行率是否在以下社区更高：未参保患者比例较大、贫困成年人比例较大、非裔美国人比例较大；在以下社区更低：提供合格的联邦健康中心（FQHC）、FQHC 类似机构和卫生部门数量更多，对有工作的父母和 Medicaid 受益人的 Medicaid 资格和支付水平更为慷慨。
在大都市统计区中，没有任何人口统计学变量与免费诊所的数量呈正相关，且具有统计学意义。然而，每 10000 名未参保人群中 FQHC 受助者的数量[发病率比（IRR）=0.69，P<0.05]、每 10000 名未参保人群中 FQHC 类似机构的数量（IRR=0.46，P<0.05）、 Medicaid 受益人的支付额（IRR=0.9998，P<0.05）和 Medicaid 资格水平（IRR=0.998，P<0.10）与免费诊所的数量呈负相关。因此，免费诊所似乎是对安全网提供者和 Medicaid 留下的特定空白做出了反应，但似乎并不是对直接需求做出了反应。
