UTILIZATION OF FREE HEALTH CLINICS IN AN UNDERSERVED POPULATION

Christina Kim, Marium Khan and Theresa Osunero

Background Information: U.S. Statistics

2009: 50.7 million1 uninsured From 2008 – 2009: people sponsored by

employment-based health insurance decreased 3.3%1

$2.5 trillion spent on health care in 20092

Unemployment rate rose to 9.6%, compared to 4.5% in 20072

Background Information

Causes of an increase in the uninsured population: Decrease in employment-based health insurance Increase in the cost of health care

Patient Protection and Affordable Care Act: Still leaves approximately 23 million people without

insurance coverage

Free Health Clinic Defined

Private, nonprofit, community-based organization Primary and secondary medical care Dental care Pharmaceutical Laboratory Mental health services

Purpose of Free Health Clinics

Over 1,000 free clinics distributed across the United States3

Nationally, free clinics serve 38% of the uninsured population

2008 - 2009, visits to community health centers by uninsured patients increased by 21%4

Providing a safety net for underserved populations

Demographics of Patients Nationally

Low-income Uninsured Disproportionately female Age:20-44 years old5 Nearly half came from rural areas6

Top Three Conditions

Top three chronic conditions diagnosed:1. Cardiovascular disease2. Hypertension3. Diabetes

Nearly one third of the uninsured nonelderly U.S. adults had at least one chronic condition7

Approximately three times more likely to seek care for chronic conditions compared to insured patients who go to physician offices5

Champaign County Christian Health Center (CCCHC)

Mid-sized organization that provides free, holistic, quality health care from volunteer physicians to anyone who lacks health insurance8

Opened Fall 2004, once a week for three hours in the evening

Served over 2,000 patients in Champaign County9

Purpose of Research Study

Determined the demographic characteristics of the uninsured people who utilized the free health clinic

Determined the purpose for client visits

Methods

Collected over 2,000 paper medical records from all patient visits from 2004 – 2009

Chi-square analysis performed using SPSS 17.0

Conditions categorized into ICD-10 Chapters

Data collected: Address, year of birth,

gender, blood pressure, height, weight, smoking status, health history, social service needs, and medical condition

Results: Patient Reason for Visit

Table 1. Patient Visits

Patient Reasons for Visit

Medical Condition 72.5

Test or Exam 21.1

Prescription Refills 6.4

Percent of Patient Visits

Percentage of patient visits is based on data collected at CCCHC

Results: ICD-10 Chapters

Percentage of Client Visits

Clinic Top ICD-10 Chapters

% of Patient Visits

National Top ICD-10 Chapters

% of Visits

Diseases of the Respiratory System

16.3 Diseases of the Respiratory System

10.6

Diseases of Circulatory System

14.9 Mental and Behavioral Disorders

7.2

Mental and Behavioral Disorders

12.4 Endocrine, Nutritional, and Metabolic Disorders

7.0

Disease of the Musculoskeletal System and Connective Tissue

9.4 Symptoms, Signs, and Abnormal Clinical and Laboratory

6.9

Diseases of the Digestive System

7.9 Findings, Not Elsewhere Classified

6.6

Results: Health Condition Breakdown Into Percentages

Table 3. Health Condition Breakdown in Percentages

Patient Characteristics Clinic County Illinois U.S.

BMIAverage 28.7 n/a n/a 26.5Normal weight 42.5 45.8 35.5 36.0Overweight 26.0 35.9 37.1 36.2 Obese 31.5 18.5 27.4 26.9

BLOOD PRESSURE Normal 36.0 76.9 71.0 43.7Pre-Hypertension 37.5 n/a n/a 25.0Hypertension 28.0 23.1 29.0 31.3

SMOKING STATUS Smoker 36.8 19.0 18.8 17.9

DEPRESSION 6.3 4.9 6.5 6.7

Results: Demographics of Patient Population

Table 4. Demographic Breakdown in Percentages

Patient Characteristics Clinic County Illinois U.S.

GENDER

Male 44.0 50.9 49.3 49.3

Female 56.0 49.1 50.7 50.7

AGE (years)

Average 39.3 28.0 35.9 36.7

18-64 90.0 70.4 63.0 62.8

65 + 6.2 10.1 12.4 12.4

UNINSURED 100.0 20.3 13.4 15.3

Discussion: Conditions

No one condition exceedingly common Most frequent reason for visit

Physical exam (17%)

Discussion: Demographics

Clinic patients were female (56%) Patients at the clinic were 18-64 years olds (90%) County residents (70%)9

Discussion: Medical Conditions (ICD-10)

1. Diseases of the Respiratory System (16.3%) Accounted for symptoms as well as diseases such as

asthma

2. Diseases of the Circulatory System (14.9%) Hypertension (28%)

Single most common medical condition diagnosed at clinic

3. Mental & Behavioral Disorders (12.4%) Depression (12%)

Could be attributed to the stress of living in poverty and being uninsured

Discussion: ICD-10 Diseases of Circulatory System

Elevated percentage of hypertension, obesity, and smoking seen in clinic patients Leading contributors to developing cardiovascular disease High prevalence unknown

Clinic County Illinois

28.0 23.1 29.0

Percentage of Patients Diagnosed with Hypertension

Percentage of Patients Diagnosed Obesity

Clinic County Illinois

31.5 18.5 27.4

Percentage of Smokers

Clinic County Illinois

36.8 19.0 18.8

Discussion: Homeless Population

121 non-residential addresses Common places known to shelter the homeless:

Local churches Homeless shelters Other community organizations

Worse health conditions and more health care needs Higher rates of medical conditions than the general

clinic population

Limitations

Hours Only about 5% of the total uninsured population in the

county Lack of standardization and inconsistency in

documentation Records did not provide ethnicity, which restricted

comparisons to previous studies Census 2000 demographic information was used

which may have been outdated at the time of the analysis

Conclusion

Clinics should offer a full spectrum of services Future studies could explore

Improvement of a health care delivery system High prevalence of smoking Obesity Self-reported social service needs Utilization of the clinic by the area’s homeless population

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Questions?

Thank you to the Provost Office and the Undergraduate Research Symposium