title: Medical Care in a Free Clinic: A Comprehensive Evaluation of Patient Experience, Incentives, and Barriers to Optimal Medical Care with Consideration of a Facility Fee.
abstract: Free and charitable clinics are important contributors to the health of the United States population. Recently, funding for these clinics has been declining, and it is, therefore, useful to identify what qualities patients value the most in clinics in an effort to allocate funding wisely. In order to identify targets and incentives for improvement of patients' health, we performed a comprehensive analysis of patients' experience at a free clinic by analyzing a patient survey (N=94). The survey also assessed patient opinions of a small facility fee, which could be used to offset the decrease in funds. Interestingly, our patients believed it is appropriate to be charged a facility fee (78%) because it increases involvement in their care (r = 0.69, p < 0.001) and self-respect (r = 0.66, p < 0.001). Incentives to medical care include continuity of care, faith-based care, having a patient medical provider partnership, and charging a facility fee. Barriers include affordable housing, transportation, medication, and accessible information. In order to improve medical care in the uninsured population, our study suggested that we need to: 1) offer continuity of medical care; 2) offer affordable preventive health screenings; 3) support affordable transportation, housing, and medications; and 4) consider including a facility fee.
authors.affiliation: University of Central Florida College of Medicine.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Birs
authors.affiliation: University of Central Florida College of Medicine.
authors.forename: Xinwei
authors.initials: X
authors.lastname: Liu
authors.affiliation: FIRE Module, University of Central Florida College of Medicine.
authors.forename: Bee
authors.initials: B
authors.lastname: Nash
authors.affiliation: Consulting Department, Sullivan Evaluation Services.
authors.forename: Sara
authors.initials: S
authors.lastname: Sullivan
authors.affiliation: Grace Medical Home.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Garris
authors.affiliation: Medical Director, Grace Medical Home.
authors.forename: Marvin
authors.initials: M
authors.lastname: Hardy
authors.affiliation: Pharmacology, University of Central Florida College of Medicine.
authors.forename: Michael
authors.initials: M
authors.lastname: Lee
authors.affiliation: University of Central Florida College of Medicine.
authors.forename: Judith
authors.initials: J
authors.lastname: Simms-Cendan
authors.affiliation: Medical Education, University of Central Florida College of Medicine.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Pasarica
keywords: barriers to healthcare; facility fee; free clinic; healthcare improvement; uninsured