Is%20There%20A%20(Volunteer)%20Doctor%20in%20the%20House?

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Is There A (Volunteer) Doctor in the House?

• The Role of Free Clinics and Volunteer Referral
  Networks in Serving the Uninsured
• Stephen Isaacs, J.D., and Paul Jellinek, Ph.D.
• Isaacs/Jellinek
• December 2007

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The Need to Provide Medical Care to the Uninsured
and the Poor has Risen Dramatically

• Between 2000 and 2005, more than 17 million
  Americans lost their health insurance or signed
  up for Medicaid
• More than one in four Americans88 million
  people is now either uninsured or covered by
  Medicaid

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Private Physicians are the Principal Source of
Primary Care for Uninsured and Medicaid Patients
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Even as the Need is Growing, the Proportion of
U.S. Physicians Providing Charity Care Has Been
Declining
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Two Options that Can Make it EasierFor Doctors
To Volunteer

• Free clinics
• Volunteer referral networks

6
Free Clinics

• Started in 1960s
• More than 1,700 currently operating
• Serve more than 2.5 million people
• Doctors go to the clinic to provide services

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Volunteer Referral Networks

• Started in 1990s
• More than 50 currently in operation
• Doctors provide services in their offices

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How These Programs Make It EasierFor Doctors to
Volunteer

• Screen for eligibility
• Distribute the burden of care equitably
• Work with PAPs and other sources to assure access
  to prescription meds
• Coordinate access to labs, specialty care,
  hospitalization
• Minimize no-shows

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Kellogg Project on Volunteer Health
Care(Completed in 2006)

• Literature review
• Expert interviews
• Meetings with national, regional, and state
  associations
• Site visits to 21 free clinics and volunteer
  referral networks

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Volunteer Programs Visited

1. Asheville, NC
2. Chicago, IL
3. Charleston, WV
4. Cleveland, OH
5. Coldwater, MI
6. Cotati, CA
7. Exeter, NH
8. Grand Rapids, MI
9. Hilton Head, SC
10. Kalamazoo, MI

• Knoxville, TN
• Maryville, TN
• Miami, FL
• Omaha, NE
• Racine, WI
• Red Bank, NJ
• San Francisco, CA
• Sevierville, TN
• Venice, CA
• Wichita, KS

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We found great variation in

• Size of program
• Staffing
• Services
• Sources of support

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Although Each Program is Unique, They Have Many
Features in Common

• Local roots
• High patient volume
• Primarily serve uninsured patients
• High proportion of immigrant patients
• Constant financial challenges

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External Challenges

• Growing demand
• Increasing burden of chronic care
• Increasing economic strain on providers
• Changing patient mix

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Service-Related Challenges

• Access to specialty care
• Access to medications
• Malpractice coverage

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Organizational Challenges

• Hand-to-mouth existence
• Lack of contact with similar programs in other
  communities
• Burnout

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The Bottom Line

• Since private physicians provide four-fifths of
  the care to uninsured and poor people, the recent
  decline in the number of physicians willing to do
  this, combined with the growing number of
  uninsured, poses a threat to the nations
  safety-net services.
• Free clinics and referral networks can make it
  easier for doctors to volunteer. Their
  experience to date illustrates the potential of
  volunteerism and also its limitations.
• Given the sheer numbers of uninsured and poor
  people25 of the U.S. population is either
  uninsured or receives Medicaidthe reach of
  volunteer programs (and, indeed, the reach of all
  institutions providing safety-net services) is
  limited, requiring a national solution.