UTILIZATION OF FREE HEALTH
CLINICS IN AN UNDERSERVED
POPULATION
Christina Kim, Marium Khan and Theresa Osunero
Background Information: U.S. Statistics

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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




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
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



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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 disease
2. Hypertension
3. 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 ICD10 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
Percent of Patient Visits
Medical Condition
72.5
Test or Exam
21.1
Prescription Refills
Percentage of patient visits is based on data collected at CCCHC
6.4
Results: ICD-10 Chapters
Percentage of Client Visits
Clinic Top ICD-10 Chapters
% of Patient National Top ICD-10 Chapters
Visits
% 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.
BMI
Average
Normal weight
Overweight
Obese
28.7
42.5
26.0
31.5
n/a
45.8
35.9
18.5
n/a
35.5
37.1
27.4
26.5
36.0
36.2
26.9
BLOOD PRESSURE
Normal
Pre-Hypertension
Hypertension
36.0
37.5
28.0
76.9
n/a
23.1
71.0
n/a
29.0
43.7
25.0
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.
Male
44.0
50.9
49.3
49.3
Female
56.0
49.1
50.7
50.7
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
100.0
20.3
13.4
15.3
GENDER
AGE (years)
UNINSURED
Discussion: Conditions
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No one condition exceedingly common
Most frequent reason for visit
 Physical
exam (17%)
Discussion: Demographics
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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
 Single
(28%)
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

Percentage of Patients Diagnosed with Hypertension
Clinic
County
Illinois
28.0
23.1
29.0
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
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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

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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

References
1.
2.
U.S. Census Bureau. Income, poverty, and health insurance coverage in the United States: 2009. Washington, DC: U.S. Department of Commerce, 2010.
Davis, Karen (2010). New Report on National Health Expenditures Underscored Need for Comprehensive Health Care Reform. The Commonwealth Fund. Retrieved from
http://www.commonwealthfund.org/Content/News/News-Releases/2010/Feb/New-Report-on-National-Health-Expenditures-Underscores-Need-for-Comprehensive-Health-Care-Reform.aspx
3.
Bureau of Labor Statistics. Local area unemployment statistics. Washington, DC: United States Department of Labor, 2010.
4.
Redlener I, Grant R. America’s safety net and health care reform—What lies ahead? New England Journal of Medicine. 2009 Dec 3; 361(23): 2201-2204.
5.
Rosenbaum S, Jones E, & Shin P. Community health centers: Opportunities and challenges of health reform. The Henry J. Kaiser Family Foundation, 2010. Available at
http://www.kff.org/uninsured/8098.cfm.
6.
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7.
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8.
Champaign County Christian Health Center (on-line). Available: www.ccchc2003.org/home.
9.
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12.
County Health Rankings. Snapshot 2010 Champaign, IL. Retrieved from http://www.countyhealthrankings.org/illinois/champaign
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U.S Census Bureau. Current Population Survey: Annual Social and Economic Supplement 2007. Washington, DC: U.S. Department of Commerce, 2008
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Behavioral Risk Factor Surveillance System. County level prevalence data. Champaign, 2007-2009. Springfield, IL: Illinois Department of Public Health.
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Center for Disease Control and Prevention. High blood pressure facts. Atlanta, GA: National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention,
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Behavioral Risk Factor Surveillance System. Prevalence and Trends Data. Centers for Disease Control and Prevntion, 2009.
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Behavioral Risk Factor Surveillance System. Illinois and Strata area prevalence data. Champaign, 2007-2009. Springfield, IL: Illinois Department of Public Health.
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Community Health Status Indicators. Vulnerable Populations – Champaign County, IL. Department of Health and Human Services, 2009.
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Hing E, Hall MJ, & Xu, J. National Health Statistics Reports. National hospital ambulatory medical care survey: 2006 Outpatient department summary. Atlanta, GA: Centers for Disease Control and Prevention,
2008.
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Questions?
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Thank you to the Provost Office and the
Undergraduate Research Symposium