The prospect of healthcare reform in the United States has free and charitable clinics worried about the future.
Current proposals to repeal and replace the Affordable Care Act have drawn fire for their potential impact on providers of last resort, otherwise known as safety-net hospitals and clinics. A multi-part report in MedPageToday takes a closer look at free and charitable clinics, finding their future bleak.
Free and charitable clinics charge patients from $0 to $20 for a visit, serving uninsured populations through volunteer- and donation-driven clinics. According to MedPage, as the percentage of uninsured patients dropped after the implementation of the ACA, free and charitable clinics found themselves with financial flexibility they had not had in the past, allowing them to stretch their budgets further than they had before. The article notes that states that expanded Medicaid saw a decrease in services provided at 43% of clinics, against 20% reporting increases. In states that failed to expand Medicaid, those numbers flipped, with 35% reporting increased demand and 18% reporting less.
Because these clinics cater to underserved communities, they are especially important for rural areas, which see disproportionate effects when for-profit hospitals close their doors, as they have in increasing numbers in recent years. Doctors serving in Alaska and Texas noted the cost of transporting patients from remote areas to any clinic at all can be prohibitive enough to force providers to take losses.
With free clinics often the only available outlet for miles around, population health tends to suffer not only from a lack of regular services, but also from a lack of community programs geared toward improving education and general wellness, according to Adrian Billings, M.D., Ph.D., who works at Presidio County Health Services in Texas. “That’s tough to deal with when you see patients who have preventable disease and chronic disease worsening due to the inability to access healthcare systems, or pay for medicines they need, or imaging,” he says.