Free Clinics Reach Out to Growing Numbers of Uninsured

In the lean, cost-cutting world of health care, a growing number of Americans have come to dread the question that typically marks the first order of business: "What's your insurance?" For those without health insurance, the right answer, "I don't have any," can easily put them on the wrong side of the health care tracks in America. Yet in the side roads of this system, there are places where the uninsured have preferred status. These places are known as "free clinics," and their numbers are growing along with those of the uninsured. "We actually turn people away who do have insurance," said Andrew Johnston, a physician who donates four hours every other week to a shift at CommunityHealth in North Chicago. Like other free clinics, CommunityHealth is a nonprofit organization supported by donations of money, equipment and time. Doctors started the clinic."It's more of a pure kind of medicine because you're not dealing with financial issues" about whether the patient can pay for the care, said Johnston, who also serves on the clinic's board. The free clinic system traces its origins to 1967. At the time, physician David Smith -- troubled by the rising tide of uninsured "flower children" arriving in San Francisco -- hung out a shingle from the second floor of a Victorian house in the Haight-Ashbury neighborhood. The Haight-Ashbury Free Clinic -- the nation's first -- became an instant mecca for youth in trouble.Twenty years later, the number of Americans without health insurance has swollen to an estimated 43 million, and free clinics have sprung up to treat populations far more extensive than footloose youth. The national foundation got a taste of the need for free clinics starting last July when Parade magazine listed it as a source of information. Since then, 1,500 letters and requests have come in. "To our total amazement, we have found an outpouring of interest in establishing clinics similar to ours from every state in the nation including Alaska and Hawaii," Avner said in a recent speech. Free clinics operate as nonprofit corporations with advisory boards consisting of health care professionals and community members. Daily operations are run by paid staff, who handle administrative work and keep money coming in, ever searching for companies and individuals willing to make a donation. Federal grants are also an important source of funding, varying from clinic to clinic.Free clinics bring the community a good return on its money, said executive director Buck Taylor of CommunityHealth. For a patient visit, his clinic's cost is $25.20, including a routine lab test and a free sample of drugs, compared with $150 at a private doctor's office for the same services, he said. To keep costs in check free clinics use volunteers and keep salaries for paid staff relatively low. Also, recent federal legislation granting free clinics immunity from malpractice prosecution has lowered both insurance fees and the threat of costly lawsuits. "We know that for every dollar we receive we can return $7 to the community in health care," Taylor said.The name notwithstanding, most "free" clinics request a small donation from patients. The Neighborhood Health Clinics Inc., in Portland, Ore., gives patients an envelope asking them to mail back an amount based on their income. But there is no pressure to give -- the envelope is anonymous, said Laura Brennan, health education prevention coordinator of the clinic, which formed in 1987 when two existing clinics merged. Some patients find that they can pay for the care they receive in other ways.At CommunityHealth -- whose client base is 82 percent Hispanic -- Jorge Rios volunteers to help with paperwork, interpreting for patients and physicians and dispensing AIDS education and awareness. In 1995, the 25-year-old from Mexico was diagnosed with a heart condition by clinic specialists and is receiving treatment there. In the meantime, Rios has begun to contribute to his adopted land. "I want to help people and I know in the United States they need a lot of hands."CommunityHealth has tapped into Chicago-area medical schools as a source of medically trained volunteers. In Florida, free clinics often seek help from the other end of the spectrum -- retired physicians and nurses. Even though hundreds of communities are finding volunteers willing to donate hours each week at free clinics, those involved are adamant that they aren't going to be able to fix what ails the health care system. "It's an answer, yes. Is it a solution? Probably not," said Taylor of Chicago's CommunityHealth. "But the estimates are correct. There are 43 million people who need care, and with Medicaid cuts we're probably going to need the (free) clinics."

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