March 4, 1997
by Nancy Weil
(ANS/CAN-EX) -- 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 truthful answer, "I don't have any," can easily put them on the wrong side of the health-care tracks in America. Yet at some places in the side roads of the system, the uninsured have preferred status.
These places are known as "free clinics," and their number is growing along with the number 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 that 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 of San Fraicisco. 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 and diverse than footloose youth.
Today 225 such clinics are in operation, according to the National Free Clinic of America Foundation in Roanoke, Virginia. Observers expect more clinics to open as both urban and rural communities struggle to fill the health care gap, widened recently with the welfare overhaul in Congress.
Fledgling free clinics face an assortment of challenges, from raising money to recruiting volunteers and finding inexpensive space. One Tampa, Florida free clinic started out in a Sunday-school classroom. Still, advocates say, free clinics are able to provide high-quality care to the working poor, homeless people and immigrants who might otherwise have no access to health care other than through hospital emergency rooms.
Free of the pressure to turn a profit, physicians, nurses, dentists, chiropractors and mental-health professionals often are able to spend more time with patients than they would in private practice. These professionals "all want to be there," said Estelle Nichols Avner, executive director of the Bradley free clinic.
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, continally searching for companies and individuals willing to make donations. 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. Free clinics keep costs in check by using volunteers and keeping 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 nopressure to give -- the envelope is anonymous, said Laura Brennan, health education prevention coordinator for the clinic, which was formed in 1987 when two clinics merged. Some patients find that they can pay for the care they receive in other ways.
Lisa Block recently took a part-time job at the Archdiocesan Health Care Network in Washington, D.C. The Catholic Charities network helps link patients at 35 free clinics in the capital, Maryland and Virginia to 200 specialists and half a dozen hospitals willing to provide free care. Block considers her work to be a "moral debt" because of her experience with a free clinic. "I've been unemployed and I went to one of the clinics and they referred me to a specialist. I was treated with such dignity," said Block, who was uninsured at the time.
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."
Started by a retired physician, Dr. Jack McConnell, in 1994, the Volunteers in Medicine clinic mobilized over a hundred community volunteers who constructed a 7,000-square-foot clinic using largely donated materials. The clinic provides free medical, dental, mental health and preventive health care to low-income residents who formerly were without access to medical care on the island.
The clinic director lobbied successfully for changes in state medical licensing laws to enable retired health professionals to obtain licenses in order to donate their services.
McConnell retired in Hilton Head 6 years ago -- "When we moved here I found it wasn't so rosy -- about 35 percent of the population had essentially no access to health care. There were several thousand people who needed care, and many retired medical people, but no way to deliver services."
Today about 40 doctors, 65 nurses, 14 dentists, and 100 lay volunteers staff the clinic, serving about 10,000 low-income people.
Several communities around the country have already replicated the Hilton Head model, and about 500 other communities have requested information.
Nancy Weil writes about education for the St. Petersburg Times. This article is reprinted with the permission of The American News Service.
Dr. Andrew Johnston, volunteer/board member, CommunityHealth, Chicago, Ill., 773-244-2663.
Estelle Nichols Avner, executive director, Bradley Free Clinic, consultant/board member, National Free Clinic of America Foundation, Roanoke, Va. 540-344-8242.
Buck Taylor, executive director, CommunityHealth, Chicago, Ill., 773-921- 9233.
Laura Brennan, health education prevention coordinator, Neighborhood Health Clinics Inc., Portland, Ore., 503-288-5995.
Lisa Block, medical specialist referral coordinator, Archdiocesan Health Care Network, Washington, D.C., 202-332-6605.
Jorge Rios, volunteer, CommunityHealth, Chicago, Ill., 773-395-9900.
Belma Gonzalez, Haight-Ashbury Free Clinic, San Francisco, Calif., 415-487- 5619.