A Report From The Field
Student-Run Free Clinics: An Equitable Local Solution to National Healthcare Disparities
Kavelin Rumalla1, Adithi Reddy1, Antonio Petralia1, Valerie J Rader2
1UMKC School of Medicine, 2St. Luke’s Health System
BACKGROUND
● Low socioeconomic status (SES) is associated with a lack of
access to healthcare which contributes to higher morbidity
and mortality rates1-3
○ Low SES is as significant a risk factor for mortality as
smoking4.
● Student-run clinics (SRCs) mitigate healthcare disparity by
facilitating greater access to healthcare for the underserved5-7.
OUR MEASURES OF HEALTHCARE OUTCOMES
Navigating Healthcare Without Insurance
● In uninsured populations, controllable conditions such as
diabetes and hypertension frequently present as medical
emergencies.
Preventative Care Precedes Emergency Care
● The uninsured are more likely to seek emergency attention
for acute exacerbations of chronic problems because they
have limited access to primary care8,9.
Primary Care Saves Lives
● People with access to routine checkups and screenings can
prevent many more severe health issues associated with
hospital stays and emergency situations10,11.
● Compared to other institutions receiving safety net funds
like emergency departments, free clinics are cost effective
options and provide quality preventative medicine
services12,13.
● Patients report equal trust in and equal care by students and
physicians in free clinics14-16.
● Student-run clinics report having a surplus of volunteers so
there is room to expand the reach of this form of
healthcare17,18.
CONCLUSION
KANSAS CITY AREA HEALTH DISPARITIES
We compared socioeconomic status, healthcare access, and
healthcare outcomes of two historically disparate counties in the
Greater Kansas City area, specifically Wyandotte County and
Johnson County, using data from the KC HealthMatters 2014
database.
Wyandotte County Johnson County
Adults with Health
Insurance19
69.2%
Preventable Hospital Stays
(Per 1000 Stays)19
66
Primary Care Providers (Per
100,000 Individuals)19
61
● Along with enriching medical student education, the care
provided by student-run medical organizations reduce the
morbidity and mortality rates of the underinsured
population6,20,21
.
● Student-run free clinics restore one major branch of medicine:
preventative medical care6,20,21.
88.4 %
55
104
● Kansas City has a group of organizations that provide
healthcare to those in need called the Safety Net.
● Sojourner Health Clinic is an example of a Safety Net SRC in
Kansas City that provides valuable preventative medicine
services and treatment to the underserved.
Socioeconomic status was examined using the following criteria:
● “Median Household Income (2014)”
● “People ages 25+ with a High School Degree or Higher (2014)”
● “Unemployed Workers in Civilian Labor Force (2014)”
● As this study is based on descriptive statistics, it is limited to
examining an apparent association rather than establishing a
statistically significant correlation between low SES and
healthcare disparities.
Healthcare access was examined using the following criteria:
● “Percent of Adult Population with Health Insurance”
● “Number of Preventable Hospital Stays per 1,000 Medicaid
Enrollees”
● “Number of Primary Care Providers per 100,000 People in the
Population”
● In future studies, goals will include assessing the effectiveness
of student-run clinics in reducing healthcare access disparities
in communities and in improving healthcare outcomes of
socioeconomically-underprivileged individuals.
SUMMARY
● We found an association between low SES and limited access
to healthcare, as outlined by the aforementioned parameters.
● This is likely a contributing factor to the low SES
demographic’s highly-increased risk of morbidity and
mortality as compared to those with greater healthcare
1-4
REFERENCES
1Health,
United States 2011: With Special Feature on Socioeconomic Status and Health. Pamphlet published by the CDC. 2011.
K., et al. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA 2000; 283: 2579–84.
3Phelan, J. C., et al. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav 2010; 51 Suppl; S28–40.
4Adler, N. E. et al. Socioeconomic status and health. The challenge of the gradient. Am Psychol 1994; 49: 15–24.
5Safety Net Health Care: Delivering Care to Vulnerable Patients. Pamphlet published by the Health Care Foundation of Greater Kansas City. 2011.
6Niescierenko, M. L., et al.. Insuring the uninsured: A student-run initiative to improve access to care in an urban community. J Natl Med Assoc 2006; 98: 906–11.
7Buchanan, D., et al. Balancing service and education: ethical management of student-run clinics. J Health Care Poor Underserved 2006; 17: 477–85.
8Zucker, J., et al. Measuring and assessing preventive medicine services in a student-run free clinic. J Health Care Poor Underserved 2013; 24: 344–58.
9Woolhandler, S., et al. Reverse targeting of preventive care due to lack of health insurance. JAMA 1988; 259: 2872–4.
10Yarnall, K. S., et al. Primary care: is there enough time for prevention? Am J Public Health 2003; 93: 635–41.
11Starfield, B., et al. Contribution of primary care to health systems and health. Milbank Q 2005; 83: 457–502.
12Fries, J. F. et al. Reducing health care costs by reducing the need and demand for medical services. The Health Project Consortium. N Engl J Med 1993: 329; 321–5.
13Watanabe, J. H., et al. Association of increased emergency rooms costs for patients without access to necessary medications. Res Soc Adm Pharm 2014.
14Isaacson, J. H., et al. Patient perceptions of having 1st- and 2nd-year medical students involved in their care. Teach Learn Med 2014; 26: 164–7.
15Ellett, J. D., et al. Patient satisfaction in a student-run free medical clinic. Fam Med 2010; 42: 16–8.
16Sojourner Health Clinic. Website published by UMKC School of Medicine. 2014; Home page. <http://www.sojournerclinic.org>
17Simmons, B. B., et al. Students who participate in a student-run free health clinic need education about access to care issues. J Health Care Poor Underserved 2009; 20: 964–8.
18Simpson, S. A. et al. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education. J Gen Intern Med 2007; 22: 352–356.
19KC HealthMatters: Community Dashboard. Searchable Health Database published by the Health Care Foundation of Greater Kansas City. 2014.
<http://kchealthmatters.org/community-dashboard>
20Zucker, J., et al. Measuring and assessing preventive medicine services in a student-run free clinic. J Health Care Poor Underserved 2013; 24: 344–58.
21Simpson, S. A., et al. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education. J Gen Intern Med 2007; 22: 352–356.
2Fiscella,
1Health,
United States 2011: With Special Feature on Socioeconomic Status and Health. Pamphlet published by the CDC. 2011.
2Fiscella, K., et al. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA 2000; 283: 2579–84.
3Phelan, J. C., et al. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav 2010; 51 Suppl; S28–40.
4Adler, N. E. et al. Socioeconomic status and health. The challenge of the gradient. Am Psychol 1994; 49: 15–24.
5Safety Net Health Care: Delivering Care to Vulnerable Patients. Pamphlet published by the Health Care Foundation of Greater Kansas City. 2011.
6Niescierenko, M. L., et al.. Insuring the uninsured: A student-run initiative to improve access to care in an urban community. J Natl Med Assoc 2006; 98: 906–11.
7Buchanan, D., et al. Balancing service and education: ethical management of student-run clinics. J Health Care Poor Underserved 2006; 17: 477–85.
8Zucker, J., et al. Measuring and assessing preventive medicine services in a student-run free clinic. J Health Care Poor Underserved 2013; 24: 344–58.
9Woolhandler, S., et al. Reverse targeting of preventive care due to lack of health insurance. JAMA 1988; 259: 2872–4.
10Yarnall, K. S., et al. Primary care: is there enough time for prevention? Am J Public Health 2003; 93: 635–41.
11Starfield, B., et al. Contribution of primary care to health systems and health. Milbank Q 2005; 83: 457–502.
12Fries, J. F. et al. Reducing health care costs by reducing the need and demand for medical services. The Health Project Consortium. N Engl J Med 1993: 329; 321–5.
13Watanabe, J. H., et al. Association of increased emergency rooms costs for patients without access to necessary medications. Res Soc Adm Pharm 2014.
14Isaacson, J. H., et al. Patient perceptions of having 1st- and 2nd-year medical students involved in their care. Teach Learn Med 2014; 26: 164–7.
15Ellett, J. D., et al. Patient satisfaction in a student-run free medical clinic. Fam Med 2010; 42: 16–8.
16Sojourner Health Clinic. Website published by UMKC School of Medicine. 2014; Home page. <http://www.sojournerclinic.org>
17Simmons, B. B., et al. Students who participate in a student-run free health clinic need education about access to care issues. J Health Care Poor Underserved 2009; 20:
964–8.
18Simpson, S. A. et al. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education. J Gen Intern Med 2007; 22: 352–356.
19KC HealthMatters: Community Dashboard. Searchable Health Database published by the Health Care Foundation of Greater Kansas City. 2014.
<http://kchealthmatters.org/community-dashboard>
20Zucker, J., et al. Measuring and assessing preventive medicine services in a student-run free clinic. J Health Care Poor Underserved 2013; 24: 344–58.
21Simpson, S. A., et al. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education. J Gen Intern Med 2007; 22: 352–356.