Central Arkansas Volunteers In Medicine Clinic, Inc.
d/b/a
HARMONY HEALTH CLINIC
Status of Organizational Efforts & Business Plan
(As of June 25, 2007)
FOR MORE INFORMATION, PLEASE CONTACT ONE OF THE OFFICERS (2007-2008 TERM)
FOR THE HARMONY HEALTH CLINIC BOARD OF DIRECTORS:
President:
Vice-President:
Secretary:
Treasurer:
Dr. K. S. Anand
Matthew House
Rev. Joyce Hardy
Amy Dunn Johnson
anandsunny@uams.edu
mhouse@jamesandhouse.com
jhardy@arkansas.anglican.org
amy.johnson@kutakrock.com
Mailing Address:
Harmony Health Clinic
201 East Roosevelt Road
Little Rock, Arkansas 72206
Executive.Director@harmonyclinicar.org
TABLE OF CONTENTS
I.
EXECUTIVE SUMMARY .............................................................................................. 4
Introduction to Harmony Health Clinic ................................................................................. 4
Organization of Harmony Health Clinic ................................................................................ 4
Scope of Services to be Provided ............................................................................................. 4
Needs Assessment/Market Analysis ........................................................................................ 4
Financial and Fundraising Plan .............................................................................................. 4
Benefits ....................................................................................................................................... 4
II.
INTRODUCTION TO HARMONY HEALTH CLINIC............................................ 5
The Concept for and Benefits of the Clinic ............................................................................ 5
The Clinic’s Mission Statement ............................................................................................... 6
Principles Underlying This Effort ........................................................................................... 6
History of This Effort ............................................................................................................... 7
The “Culture of Caring” .......................................................................................................... 8
Legal Status ............................................................................................................................... 8
III.
ORGANIZATION/IMPLEMENTATION OF HARMONY HEALTH CLINIC... 9
Board of Directors..................................................................................................................... 9
Advisory Committees.............................................................................................................. 11
Staff .......................................................................................................................................... 12
Volunteers ................................................................................................................................ 13
Community Partners .............................................................................................................. 13
IV.
SCOPE OF SERVICES TO BE PROVIDED ........................................................... 14
Anticipated Medical Services ................................................................................................. 14
Specialty Medical Services ..................................................................................................... 15
Prescription Drugs .................................................................................................................. 15
Chaplaincy Program ............................................................................................................... 16
Children’s Services ................................................................................................................. 16
Other Services ......................................................................................................................... 16
Patient Eligibility .................................................................................................................... 17
Clinic Location and Facilities ................................................................................................ 18
Volunteer Screening, Training, and Protection ................................................................... 18
V.
NEEDS ASSESSMENT/MARKET ANALYSIS ....................................................... 19
The Problem: Lack of Access to Health Care ..................................................................... 19
The Problem: Lack of Access to Health Care in Arkansas ................................................ 23
The Statistics: What Difference Does The Lack of Access to Health Care Make in Our
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Community? ............................................................................................................................ 24
The Statistics: How Many Americans and Arkansans Lack Health Insurance? ............ 25
The Statistics: Who Are Our Uninsured Neighbors? ......................................................... 26
The Statistics: Pulaski County, Arkansas Demographics In Particular ........................... 27
The Statistics: The Pool of Potential Medical Volunteers .................................................. 39
Existing Local Charitable Health Clinic Resources ............................................................ 40
VI. FINANCIAL AND FUNDRAISING PLAN ...................................................................... 43
Start-Up Budget and Two-Year Operating Budget ............................................................. 43
Funding Requirements ........................................................................................................... 44
Fundraising and Development Efforts .................................................................................. 44
Accounting ............................................................................................................................... 45
REFERENCES CITED .............................................................................................................. 46
APPENDIX .................................................................................................................................. 51
A --- Harmony Health Clinic Bylaws Adopted April 11, 2007
B --- Federal Poverty Guidelines (Current Year)
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I.
EXECUTIVE SUMMARY
Introduction to Harmony Health Clinic
Harmony Health Clinic will be a free medical and dental clinic located in Little Rock,
Arkansas. The Clinic will provide routine health care to local residents whose income does not
exceed 200% of the Federal Poverty Level and are currently medically uninsured and between
the ages of 18 and 64. The Clinic will open and commence providing limited, but gradually
expanding, services, as soon as the physical facilities and operating funds to accomplish this goal
are available.
Organization of Harmony Health Clinic
The Clinic is an Arkansas non-profit corporation and filed for 501(c)(3) tax-exempt status
with the Internal Revenue Service on April 10th, 2007. A Board of Directors will oversee the
paid staff who will direct the activities of the vast pool of medical and non-medical volunteers.
Scope of Services to be Provided
The Clinic will provide free, high quality, primary medical and dental care and
preventive health services in loving and caring environment.
Needs Assessment/Market Analysis
Within the Little Rock area alone, there are many thousands of medically uninsured and
underserved individuals who meet the 200% Federal Poverty Level criteria for this free clinic.
Financial and Fundraising Plan
A two-year budget is presented along with estimated start-up costs. All accounting
policies and procedures will be strictly followed. In order to purchase property, commence
operations and to operate for one year, the Clinic needs cash contributions in the range of at least
$ 500,000 to 600,000. Fundraising and development efforts have commenced, and pledges are
being obtained from 100% of the members of the Board of Directors.
Benefits
Benefits will extend beyond the uninsured families that receive services through
Harmony Health Clinic. Such benefits include a reduction in the inappropriate use of hospital
emergency rooms, a healthier community workforce, and an improved quality of life for our
residents. In addition, our volunteers will experience a sense of satisfaction and accomplishment
in having provided essential services to fellow community citizens in a caring environment.
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II.
INTRODUCTION TO HARMONY HEALTH CLINIC
The Concept for and Benefits of the Clinic
Accessible, affordable health care for uninsured and underserved individuals has emerged
as perhaps the most entrenched and complicated crisis for the public and private sectors in the
medical arena. The problems associated with the unmet medical needs of over 45 million
uninsured Americans are well-documented and oft-discussed in political and government circles
but affordable solutions are not evident. The State of Arkansas, and Pulaski County in particular,
are not exempt from the tremendous human and fiscal price exacted by the lack of access to
proper acute and preventive medical care for the many uninsured people in our community.
Harmony Health Clinic has therefore been organized to complement other charitable
efforts to address this problem, and to provide free, routine, non-emergency, medical and dental
services to individuals between the ages of 18 and 64 without medical insurance (whether
private, Medicare, Medicaid, ARKids First, etc.) and whose income does not exceed 200% of the
Federal Poverty Level. Volunteer physicians, nurse practitioners, physician assistants, dentists,
pharmacists, therapists, nurses, technicians, and medical and non-medical assistants will provide
services at Harmony Health Clinic.
As described in more detail below, this health care delivery system is modeled after the
Hilton Head, South Carolina “Volunteers In Medicine Clinic” that opened in 1993. It now
serves many thousands of patients each year and has been used as a model for dozens of other
VIM clinics now operating across the United States of America, and many more currently in
development. Harmony Health Clinic is the only Arkansas-based charitable health clinic
formally affiliated with the Volunteers In Medicine Institute (which originated from the initial
Hilton Head VIM clinic), notwithstanding the numerous other charitable health clinics in
Arkansas already delivering medical care to those in need. The adverse effects resulting from
lack of access to health care in Little Rock, however, are too great for these existing efforts to
address on their own, thus leaving a void which Harmony Health Clinic intends to help fill.
Many doctors, dentists, and other healthcare professionals in the Greater Little Rock area
have expressed an interest and indicated their willingness to volunteer their services to Harmony
Health Clinic. With a formal Volunteers In Medicine Institute model in place, dozens more
active and retired physicians will donate their time to this worthwhile and necessary cause. In
addition to the commitment of the area’s medical providers, the rich history of generosity,
volunteerism, and civic engagement among individuals and entities in our community ensures
the ultimate success of Harmony Health Clinic.
The many and myriad benefits of the Harmony Health Clinic will include:
—Providing benefits to those who have been excluded by delivering health care
in a caring environment that ministers to the whole person.
—Providing benefits to hospitals by caring for those patients receiving primary
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care services or catastrophic care in the emergency room, most of which
are non-reimbursed services; these patients will receive preventive and
primary care for in an appropriate setting.
—Providing benefits to the public by keeping individuals healthy and productive
members of the community.
—Providing benefits to local businesses by increasing the health and wellness of a
substantial part of their work force.
—Providing benefits to care givers and volunteers by building a sense of
community and caring that transcends barriers and delivers a sense of joy
and worth to those who serve.
The Clinic’s Mission Statement
The Harmony Health Clinic will seek to understand and serve the health and wellness
needs of the medically uninsured and underserved who live in Central Arkansas, by providing
access to quality medical care at no cost to these patients in a private, community-based clinic,
staffed by volunteer professionals and marked by a unique atmosphere of caring, compassion,
respect, dignity, and diversity.
Principles Underlying This Effort
It has been said that while philanthropy is commendable, it must not cause the
philanthropist to overlook the circumstances of economic injustice which make philanthropy
necessary. While Harmony Health Clinic is wholly focused upon its mission of providing
medical services without regard to a patient’s inability to pay, it is and will remain distinctly
aware of the reasons for its very existence.
Specifically, the Clinic’s founders are committed to advancing social justice through the
provision of quality health care to those who are denied it by virtue of barriers such as
socioeconomic status. We believe that universal access to decent health care is integral to the
sanctity, development and enjoyment of life, and vital to an individual’s ability to fully realize
one’s dignity and potential. Virtually every religious faith (and their denominations) takes the
position that access to decent health care is and should be recognized as a basic human right, and
that the prevailing health care system in this country utterly fails to protect that right when it
does not ensure adequate coverage for all Americans.
A fundamental measure of a society is how it cares for and protects its poorest, least
powerful, and most vulnerable members. It is therefore unjust and unacceptable that in the
wealthiest nation on Earth, tens of millions of children and adults struggle daily to live, learn,
and work without access to basic health care, especially when the primary distinction between
those with access and those without lies only in their inability to pay. We as a people are
responsible for the society in which we reside, and have a moral obligation to work to remove
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social barriers which perpetuate inequities and inhibit the common good from being achieved.
The current system of rationing a necessity so vitally important as decent health care, solely upon
the basis of one’s socioeconomic status, fails to satisfy the most basic tenets of social justice.
With the foregoing in mind, and while mindful of St. Augustine’s view that “charity is no
substitute for justice withheld,” the principal mission of the Harmony Health Clinic is not to
pressure nor petition America’s political leaders for meaningful reform, such as some form of
universal health care system which ensures comprehensive health care benefits for all
Americans. Rather, the Clinic’s aim is to directly provide that access in the absence of such
system, and until such day as that system is in place. Confident that such a day will inevitably
come, and consistent with the belief that health care is a right of the masses rather than a luxury
for the privileged few, in the interim we are fully and faithfully committed to freely providing
quality health care on the basis of medical need rather than material wealth.
History of This Effort
This effort was formally originated as a non-profit corporation on July 25, 2006 as
“Central Arkansas Volunteers in Medicine Clinic, Inc.” (CAVIMC), and stemmed from a group
of concerned citizens who began meeting in August 2005 to explore ways in which to serve the
uninsured and underserved population who lives in Central Arkansas but does not have sufficient
access to healthcare. CAVIMC will conduct its operations as “Harmony Health Clinic.” The
name symbolizes not only the inner-connectedness between a healthy mind, body, and spirit, but
also reflects the unique diversity of both the individuals who have collaborated to found this
Clinic but also the diversity of those who will benefit from its services.
After months of meeting and brainstorming, the original group formally affiliated with
the Volunteers In Medicine Institute based in the State of Vermont
(www.volunteersinmedicine.org) to obtain their assistance in helping to start a VIM-modeled
clinic in the Central Arkansas area. In March 2006, funds generously provided by the Arkansas
Conference of the United Methodist Church were utilized to cover the travel-related expenses of
hosting a VIM representative for a series of public forums wherein ideas were explored as to
how to start a free clinic. The assistance of the Arkansas Association of Charitable Clinics
(www.aacclinics.org) and help from various other free clinics and interested individuals and
entities was also crucial to the success of the early efforts.
The Volunteers in Medicine Institute itself originated from an effort in Hilton Head,
South Carolina. In 1992, one out of three people who lived on Hilton Head Island had no access
to health care. At the same time, a number of retired medical personnel (physicians, nurses,
dentists) began expressing an interest in finding a way to continue practicing their profession on
a voluntary, part-time basis to help those without access to care. So in 1993, a group led by Dr.
Jack McConnell brought these two groups together and created the Volunteers in Medicine
Clinic, a 501(c)(3) free health clinic utilizing retired health care professionals
(www.vimclinic.org). The response from the medical community was extraordinary: 55
physicians, 64 nurses, and 15 dentists were recruited, all of whom were retired. They were able
to do what they always wanted to do: to be able to practice their professions in a "hassle-free"
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environment.
The “Culture of Caring”
Like the original VIMI clinic and other VIMI clinics, this "Culture of Caring" will be the
heart and soul of the Harmony Health Clinic. It is rooted in an ethical standard in medicine that
was once practiced and should be again: how people are treated during a visit to the Clinic is as
important as the medical care they receive. Those who will come to our Clinic will be good
people in need of help. Surviving on limited resources, they often exhibit great courage simply
trying to get through each day. Our “Culture of Caring” will recognize the strengths of those in
need and respect their dignity. We will seek to heal not only physical illnesses, but also the
injury caused by bias, prejudice and indifference.
The “Culture of Caring” concept is summarized by the following vision statement which
guided the original VIM Clinic and has guided many others since: “May we have eyes to see
those that are rendered invisible and excluded, open arms to reach and include them, healing
hands to touch their lives with love, and in the process, heal ourselves.” Policies and procedures
for implementing and maintaining the "Culture of Caring" will be established as a required
component of our Clinic. It is essentially a two-part philosophy: The first is the belief that
healing begins when you greet a person at the door, invite him or her in, take an interest in the
life of the person and give them the dignity and respect that often has not been shown elsewhere
in their life. The second is the recognition that perhaps the greatest healing ultimately does not
go to the people who come to the Clinic to receive care, but instead to the volunteers who go
there to provide it.
Legal Status
Harmony Health Clinic:
—Has filed its Articles of Incorporation and Application for Fictitious Name with
the Secretary of State, and is authorized to conduct business in the State of
Arkansas as Central Arkansas Volunteers In Medicine, Inc. d/b/a
Harmony Health Clinic
—Has obtained a federal tax identification number
—Has filed for federal 501(c)(3) tax-exempt status with the Internal Revenue
Service (application pending approval)
—Will apply for any necessary licenses required for operating a medical clinic,
dental clinic, and pharmacy
—Will apply to the Arkansas State Board of Pharmacy for a permit to operate as a
charitable clinic so that medications may be legally dispensed on-site
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—Will participate in and comply with the Free Clinic Federal Tort Claims Act
(FTCA) Medical Malpractice Program described in Section 194 of the
Health Insurance Portability and Accountability Act of 1996 (HIPAA), the
effect of which will provide Harmony Health Clinic’s volunteer health
care professionals with immunity from medical malpractice lawsuits
resulting from their subsequent performance of medical, surgical, dental or
related functions within the scope of their work at the free clinic
(claimants alleging acts of medical malpractice by the volunteer health
care professional will be required to file any claims against the United
States of America, and payment of any claim is subject to Congressional
appropriations for the program)
—Will register with the Arkansas State Board of Health and comply with the
requirements necessary to ensure that its volunteer licensed health care
professionals, and volunteer students acting under their supervision, are
granted immunity (absent gross negligence or willful misconduct) from
civil damages for medical care rendered at free or low-cost clinics
pursuant to the Arkansas Volunteer Immunity Act (as amended and
expanded in 2007)
III.
ORGANIZATION/IMPLEMENTATION OF HARMONY HEALTH CLINIC
Board of Directors
The Bylaws of Harmony Health Clinic have been completed, adopted, and will govern
the decisions of the Clinic. See Appendix A (copy of Bylaws). In addition, complete medical
and business procedures are being written by certain committees discussed below and will be
approved prior to commencement of operations. The start-up and ongoing operations of
Harmony Health Clinic will have the oversight of a Board of Directors. The founding Board was
installed on April 11, 2007 and each of its Members will serve either one-year, two-year, or
three-year terms. Additional Board Members will be added from time to time in accordance with
the Bylaws. Directors and officers liability insurance is being procured for purposes of
insulating against liability resulting from decision-making by the Board.
The Board’s initial officers, and biographies for the current Board Members, are listed
and described below:
President:
Vice-President:
Secretary:
Treasurer:
Dr. K. S. Anand
Matthew House
Rev. Joyce Hardy
Amy Johnson
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Kanwaljeet “Sunny”
Anand, MBBS, D.Phil.
Brenda Fiser
Rev. Patricia Joyce
Hardy
Thomas David Hoffpauir
Robert H. Hopkins, Jr.,
MD, FACP, FAAP
Matthew House, JD
Amy Dunn Johnson, JD
Physician and scientist; Professor of Pediatrics, Anesthesiology, Pharmacology, Neurobiology
and Developmental Sciences at UAMS, College of Medicine; Inaugural recipient of the Morris
& Hettie Oakley Endowed Chair in Pediatric Critical Care Medicine; Currently Director of Pain
Neurobiology Laboratory and member of the Board of Directors, Arkansas Children’s Hospital
Research Institute; Currently practicing in the Pediatric ICU at Arkansas Children’s Hospital;
Served as a Board Member for the National Summit on Race (2002); National Council for
Communities and Justice, NCCJ in Arkansas (2003-2006); RESCUE Foundation in India (since
2001); President of the Sri Sathya Sai Baba Center of Little Rock (1998-2002, 2004-2008).
Church Council, Quapaw Quarter United Methodist Church (2003–2006); Chair 2007 Board of
Trustees, Quapaw Quarter United Methodist Church (2002–2005); Chair 2006 Finance
Committee, Quapaw Quarter United Methodist Church (2003-2005); Chair 2005 Pastor-Parish
Relations Committee, Quapaw Quarter United Methodist Church; 2007 Board of Directors, St.
Theresa’s Catholic School (1993–May, 2000); President-elect (1994-1995); President (1995May, 2000); Board of Directors, Camp Aldersgate, Inc. (1990–1996), Secretary & Program
Committee Chair (1991-1996); Allocation Volunteer, United Way (1997 and 1998); Chair,
Service Based Focus Group, Pulaski County TEA Coalition (1997-August, 2000); Board of
Directors, Pulaski County TEA Coalition (1997–Present); Secretary (1998–August, 2000);
Public Relations Volunteer, Arch Street Volunteer Fire Department (1994–Present); Recording
Secretary, Arch Street Water Improvement and Fire Protection District 116 (1997–Present)
Archdeacon for Ministry Development for the Diocese of Arkansas; Represents the Diocese on a
number of networks including the Arkansas Interfaith Alliance, Arkansas Advocates for
Children and Families, Arkansas Coalition for Economic Security, the Arkansas Coalition for
Peace and Justice, and the Arkansas Hunger Coalition; Worked with a group to start the Deacon
Formation Program in the Diocese of Arkansas; A member of the North American for the
Diaconate and presently serves as the Secretary of the Board; Also served as the Program Chair
for NAAD conferences; In the Diocese of Arkansas, she has served on the Commission on
Ministry and is currently a consultant to the COM; An Alternate Deputy to General Convention
(2003 and 2006).
Therapist in the UAMS Department of Psychiatry – STRIVE Program; Holds a Master’s Degree
in Social Work from the UALR – Graduate School of Social Work; Is active on several
volunteer boards and committees in addition to this board; Was appointed to the Arkansas
Supreme Court/ Administrative Office of the Court’s Court Improvement Program; Appointed to
the Arkansas Supreme Court’s Ad Hoc Foster Care Committee; A member of the Artspace
Board; Chair of the HeARTwork Arts and Spirituality Committee, Quapaw Quarter United
Methodist Church, where he and his family are active members; A professional musician having
toured and performed nationally and internationally; A recording artist with several major and
independent label credits.
Faculty Physician (1993-present) and Associate Professor (2000-present), UAMS; Board
Certified in Internal Medicine and Pediatrics; Director of UAMS Internal Medicine-Pediatrics
Residency Program; Governor (2007-2011) of Arkansas Chapter of American College of
Physicians; Little Rock First United Methodist Church Board (2005-2007); Volunteer Physician,
River City Medical Clinic (1995-present).
Graduate of Hendrix College with Bachelor of Arts degree and Politics major; Graduate of the
University of Arkansas-Little Rock School of Law; Attorney, James & House, P.A. in Little
Rock, Arkansas; Member of Arkansas Bar Association, Pulaski County Bar Association, and
Arkansas Trial Lawyers Association; Volunteer, Center For Arkansas Legal Services (1999Present); Board of Stewards, Pulaski Heights United Methodist Church, Little Rock, Arkansas
Graduate of Hendrix College; Graduate of the University of Arkansas-Little Rock School of
Law; Attorney, Kutak Rock LLP; Member, American Health Lawyers Association; Member,
William R. Overton Inn of Court; Volunteer Guardian and Human Rights Committee Member,
Alexander Human Development Center; Chapter AK PEO Treasurer (2006-present).
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Elizabeth Karpoff, BSN,
RNP
Rev. Betsy Singleton
Bud B. Whetstone, JD
Registered Nurse Practitioner in Little Rock, Arkansas; Four years as Director of Health
Promotion/Community Outreach and Director of the Community/Free Clinics for the Uninsured
at St. Vincent Health System; Five years as Coordinator for the Health Ministry Program at St.
Vincent Health System; Board Member, Arkansas Association of Charitable Clinics for 2 years;
Board Member, St. Francis House for 4 years.
Distinguished graduate of Hendrix College, where she received a B.A. in English; Entered
Perkins School of Theology at Southern Methodist University, Dallas, Texas (1987), graduated
magna cum laude (1991) with a Master of Divinity, receiving recognition in preaching and
biblical studies; Ordained a United Methodist elder in full connection (1993); Has worked in
small charges of 2 and 3 churches in South and East Arkansas; Chaplain, University of Arkansas
for Medical Sciences; Youth pastor for a Korean congregation; Served a congregation of more
than 3,000 members with a television ministry; Currently pastor of an urban congregation in the
historic Quapaw Quarter district near the Governor’s Mansion in Little Rock; Assigned to the
Quapaw Quarter United Methodist Church as senior pastor; Has previously served on the Board
of Directors of the General Board of Global Ministries of the United Methodist Church; Has led
workshops locally and at general church events, such as The United Methodist Women’s
Assembly; Was voted The Town and Country Pastor of the Year (2002).
Received his law degree at University of Mississippi; Recipient of the Golden Gavel Award;
Outstanding Trial Lawyer Award [1986-1987]; Lawyer Citizen Award [1988]; Listed in Best
Lawyers of America. Contributor: Featured Article, “Whetstone Greatest Hits,” National Law
Journal [1986]. Co-Author: Arkansas Workers Compensation Desk Book [1978-1987]. Fellow:
Arkansas Bar Foundation; Arkansas College of Trial Lawyers; American College of Trial
Lawyers; Outstanding Lawyer Humanitarian Award by the Arkansas Bar Association;
President’s Award from the Little Rock Boys and Girls Club; Currently on the Board of
Directors at P.A.R.K. and the Little Rock Boys and Girls Club.
Advisory Committees
The Board of Directors has appointed committees to plan and implement medical and
business start-up activities, fundraising, facilities and other activities necessary to develop
Harmony Health Clinic. Specifically, until such time as the Clinic becomes operational, the
following advisory committees will make recommendations to the Board of Directors with
respect to matters that require action in preparation for operation of the Clinic. Each advisory
committee consists of volunteers, with at least one member of the Board of Directors also
serving on such committee. These committees will continue in existence until dissolved by
resolution of the Board of Directors.
Legal/Financial Committee The Legal/Financial Committee is responsible for
researching clinic licensure requirements and initiating necessary applications; preparing
applications for nonprofit 501(c)(3) status; establishing bookkeeping and accounting
systems; preparing recommended budget and business plan; and obtaining appropriate
insurance coverage for the clinic, board of directors, staff, volunteers and professionals.
Program Development Committee The Program/Development Committee is
responsible for overseeing completion of the feasibility study/needs assessment and
executive summary; researching potential information systems and making
recommendations for computer software management and electronic medical record
programs; developing job descriptions for lay staff and volunteers; establishing a
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recruitment, training, orientation and supervision plan (including training manual and
recruitment materials) for all volunteers; and working with the Medical Committee to
prepare orientation and training materials for medical volunteers.
Medical Committee The Medical Committee is responsible for advising on all
clinical aspects of operating the clinic including scope of services, referral system for
tertiary care, specialty care and diagnostics; establishing job descriptions for
medical/clinical staff and volunteers; establishing procedures for credentialing
professionals, quality assurance, clinic policies, professional supervision, and clinical
staffing; and making recommendations for functional layout of clinical space, equipment
and supplies, pharmaceutical provisions and other related clinical operations.
Facilities Committee The Facilities Committee is responsible for determining the
requirements for the clinic’s physical space, including functional layout and design, cost,
site location, OSHA requirements, and environmental impact; exploring options for
possible donations of building or land; making recommendations to the Board regarding
purchase, lease, renovation, or construction of clinic facilities; and initiating process of
obtaining building permits, donated materials, equipment, supplies, decorator services,
and landscaping.
Development/Fundraising Committee The Development/ Fundraising Committee
is responsible for responsible for creating a development plan for annual operations and
possible capital campaign and endowment and for overseeing grant writing, private
solicitation, and fundraising efforts.
Media/Public Relations Committee The Media/Public Relations Committee is
responsible for developing a marketing plan which includes establishing a relationship
with the media in order to promote the clinic on a regular basis to generate awareness of
the clinic’s needs and progress; generating awareness among potential patient groups;
establishing a system for communicating with current and prospective volunteers, as well
as prospective financial supporters; establishing a website and other advertising
materials.
Staff
The ongoing operations of Harmony Health Clinic will have the oversight of the abovedescribed Board of Directors. A Medical Director and a Dental Director will generally oversee
the provision of health care at the Clinic. A salaried staff (with specific positions and job
descriptions to be determined) will carry out the daily operations and monitor the delivery of
services, the coordination of volunteers, the assistance of patients, and the solicitation of funds
and in-kind donations. It is anticipated that, as a minimum, the salaried staff will consist of an
Executive Director and a Nursing Director in addition to other part-time positions.
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Volunteers
The exceptional nature of the Volunteers in Medicine model is underscored by its name:
services are delivered by volunteer medical and lay staff. Only certain administrative or
specialized positions shall be paid, with wages commensurate with the Clinic’s non-profit
mission. The Greater Little Rock area is fortunate to include a vibrant and generous community
that includes a wealth of active and retired medical personnel, students, lay volunteers and other
individuals who liberally and consistently donate their time to community causes. As such,
Harmony Health Clinic anticipates few barriers to recruiting sufficient volunteers to staff the
clinic appropriately.
As of the end of May 2007, dozens of individuals with both medical and non-medical
backgrounds have expressed a desire to volunteer their time and services at the local clinic. A
network of nurses, pharmacists, and other medical specialists is being established to volunteer
their services. The Medical Committee within the Clinic’s organization will assess the
qualifications and credentialing requirements of each health care provider, including but not
limited to licensure, continuing medical education, health fitness, and previous training and
experience. In addition to physicians, dentists and pharmacists, health care providers will
include licensed Advanced Practice Nurses, medical students, licensed residents or fellows in
training, under the supervision of licensed health care professionals. In addition, nursing
students, pharmacy students, and other allied health professionals will participate in the care
provided, under the supervision of licensed individuals from that professional discipline.
In addition to the volunteer medical personnel, Harmony Health Clinic is reaching out to
the members of the community with no medical background whose desire to help is based solely
upon improving the quality of life in our area. The Clinic will offer an opportunity for these
individuals to contribute to our community by assisting in the daily operations of the Clinic in
non-medical capacity.
Community Partners
The Volunteers in Medicine model presupposes strong support from both the public and
private sectors. Harmony Health Clinic will be a community-driven clinic intended to
complement pre-existing services’ and agencies’ missions and expand upon successful models of
delivering healthcare to the uninsured. Indeed, the Greater Little Rock area features a generous
and engaged community that deeply cares for its neighbors. As such, there is an existing
network of social service agencies and nonprofit organizations that provide care and services to
the least fortunate among us. Harmony Health Clinic will tap into this existing network in order
to make eligible citizens aware of the services available from the clinic.
However, the lack of access to healthcare is a problem that reaches far beyond those who
are regularly eligible for other social services. Because of this the Clinic will work with
community institutions that interact with the population at large to see that all are aware of the
clinic and the services it offers. The Clinic will partner with churches, government agencies,
local schools and universities, and, of course, local hospitals and health care providers, to make
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the Clinic’s services known. The Clinic is already a member of the Arkansas Association of
Charitable Clinics, and intends to apply for membership to the National Association of Free
Clinics.
The groundwork for the public outreach efforts have already begun as government
officials, other nonprofits, and area clergy are increasingly becoming aware and supportive of the
efforts to establish Harmony Health Clinic. Meanwhile, the Clinic’s Media/Public Relations
Committee will also work to complete development of its public outreach materials. A customdesigned website for the Harmony Health Clinic is currently under construction and will be
launched soon.
IV.
SCOPE OF SERVICES TO BE PROVIDED
Anticipated Medical Services
Harmony Health Clinic plans to offer the following medical services at no charge to the
patient. The scope of services may obviously need to be limited at start-up and modified (and
ideally expanded) from time to time. Of course, the availability of services at any given time
depends upon the corresponding availability of medical volunteers, resources, equipment, and
funding. The Clinic will not be able to offer disability evaluations for any patients.
—Outpatient primary medical care such as diagnosis and management of chronic
disorders, diabetes mellitus, hypertension, arthritis, hyperlipidemia,
obesity, irritable bowel syndrome, gastroesophageal reflux disease,
chronic rhinitis and allergies. The clinic will diagnose and treat acute
disorders such as otitis media, acute pharyngitis, bronchitis, upper
respiratory infections, mild community-acquired pneumonia, urinary tract
infections, rashes, skin infections, and back and muscle strains.
—A limited number of medical tests will be available and non-scheduled
medications will be dispensed as available (see “Prescription Drugs”
below).
—Preventive medical services will include physician and medical professional
counseling based upon the individual needs of patients. Seminars as well
as educational literature will be offered on specific medical issues and
lifestyle impact on health. Information on programs for smoking
cessation, alcohol and drug addiction referral and/or rehabilitation will be
made available. Nutritional experts plan to provide educational literature
and personal counseling for those with special dietary needs.
—Dental care will be provided in a full service dental clinic, including
preventive, restorative, and limited prosthodontic care (with radiological
investigations, dental hygiene, extractions, fillings and other care) as
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defined by the Dental Committee.
—The Clinic will seek out the help of optometrists, opticians, and other eye care
professionals at least twice per month. In doing so the Clinic hopes to
affiliate with individual optometrists and corporate outfits, as well as the
Lions Club, to solicit the donation of eyeglass frames and a limited
number of lenses prescribed by the optometrist and fitted for each patient.
—There is a tremendous need in our community for expanded availability of
basic mental health services such as diagnosis of psychological and mental
health issues, and brief solution-focused individual therapy or group
therapy sessions. It is hoped that such services can someday become
available at Harmony Health Clinic.
—Physical Therapy, Occupational Therapy and Chiropractic Care may be
available on occasion based upon the pool of available volunteers.
Specialty Medical Services
The scope of services as defined above does not guarantee access to specialist referrals or
advanced medical services. Limited commitments will be sought from as many specialists as
possible, but these will in all likelihood be limited to the initial evaluation only. Following the
initial evaluation, the subsequent care will necessarily have to be handled on a case-by-case
basis. For the majority of patients, basic monitoring and adjustment of medications can be
coordinated by return visits to the charitable clinic. If major changes are required, the Clinic
physician can call the patient back after 1-3 days, thereby having time for a brief phone
consultation with the specialist.
The Clinic will seek to work closely with other medical facilities in the vicinity by
referring patients for advanced medical services requiring specialized expertise or services not
available on site such as:
—Radiographic studies
—Diagnostic tests on blood, urine, or other body fluids
—Gastrointestinal endoscopy
—Surgical services and advanced eye care
Prescription Drugs
Similar to other charitable health clinics, Harmony Health Clinic plans to provide
appropriate drugs and medications to its patients at no cost. Generic drugs will be used
whenever possible. The Clinic will strive to seek out free and low-cost sources for ongoing
prescription drug needs for its patients. Many of these sources have already established
relationships with other charitable clinics in Arkansas. The Clinic will also utilize drug samples
when available. When medications needed by a patient are not available through the Clinic, we
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will attempt to work with the patient to help them locate the lowest cost options available.
Extensive use of and participation in free medication programs provided by the major
pharmaceutical manufacturers for uninsured individuals will also be utilized. Also, the Clinic
intends to participate in the Arkansas State Board of Pharmacy-supervised prescription drug
redispensing program.
Volunteer pharmacists will be vital for purposes of assuring quality prescriptions and
assisting to prevent errors in dosage and cross-reactions with other medications taken by the
patients. The Clinic will include a secure, limited access area for drug storage, but no narcotics
or controlled substances will be dispensed or kept on site.
Chaplaincy Program
Despite its origins, Harmony Health Clinic is not formally affiliated with any particular religious
faith, denomination, or organization, and in fact is composed of individuals from a wide array of
religious backgrounds. However, consistent with the Clinic’s aim to address all aspects of a
person’s health, the Clinic intends to maintain a chaplaincy program which may include on-site
or on-call chaplains or chaplaincy interns. These services will include personal and confidential
spiritual, ethical and moral consultation when requested by the patient.
Children’s Services
Because of the existence of government programs assisting children in need of health care
services, Harmony Health Clinic’s target population is focused upon individuals between the
ages of 18 and 64 who do not have health insurance (private, Medicare, Medicaid, ARKids First,
etc.) and whose income does not exceed 200% of the Federal Poverty Level. Of course, these
individuals often have children, incapable of being left alone at home, who necessarily must
attend their parent’s or guardian’s appointment at the Clinic.
Accordingly, depending upon its physical facilities, the Clinic hopes to provide a staffed
nursery/child care area for the children of parents who are being treated in the Clinic. At the
very least, the Clinic intends to maintain a “reading room/play area” stocked with toys and ageappropriate literature. Similar to the nursery, volunteer youth and adult readers will staff the
reading room and, continued donations allowing, children will be encouraged to take home a
book with them when they leave the Clinic.
Other Services
—Escorts will be provided to befriend and help patients through the process of being
treated in the Clinic.
—The Clinic desires to locate either on or close to the bus route, but depending upon the
need, the Clinic may attempt to arrange for a shuttle service to be provided at
particular times to take patients from the nearest bus stop to the clinic and back.
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—Since the Clinic intends to operate on certain nights and weekends (in order to
accommodate patients and providers who work during the day), the Clinic intends
to hire off-duty local police officers to help ensure security at the facility and in
the parking lot, in order to ensure a peace of mind for patients, volunteers, and
paid staff.
—Translation and interpretation services for Spanish-speaking patients will be provided
as available, and other language services may be available on an “as needed”
basis. Arrangements will be made for individuals trained in sign language for
helping our hearing-impaired patients.
Patient Eligibility
Consistent with Harmony Health Clinic’s effort to address a specific segment of our
population that is underserved with respect to health care, patients seeking the Clinic’s assistance
will need to satisfy four criteria in order to be eligible for services:
(1) Residence—The patient must have lived or worked in Pulaski County, Arkansas for at
least the three months prior to seeking the services.
(2) Uninsured—The patient must not already have private medical insurance, and not be
eligible for Medicare, Medicaid, VA benefits, or ARKids First.
(3) Age—The patient’s age must be between the ages of 12 and 64, and otherwise
ineligible for services through the ARKids First and Medicare programs.
(4) Income—The patient’s income must not exceed 200% of the Federal Poverty Level
based upon the size of the patient’s immediate family. See Appendix B for the
most current chart.
The Clinic will institute documentation requirements in order to ensure compliance with
these eligibility criteria. Also, the Clinic will recertify its patients every few months from their
starting certification date in order to ensure that patients remain eligible for services. If a patient
qualifies for a government or private program, the Clinic will refer the patient to the appropriate
agency but will treat the current episode while the appropriate enrollment is pursued. Those
between jobs will also be considered eligible for clinic services.
Patients seeking treatment that do not meet eligibility criteria will be handled on a caseby-case basis. The Clinic’s policy will be to treat every eligible patient that visits the clinic.
However, depending upon the requirements or limitations of funding and resources available to
the Clinic, eligibility criteria may be modified from time to time.
The Clinic will continually assess the needs of the target population and adjust services
and staffing to achieve the mission and vision of the Clinic. Moreover, referral sources will be
identified and coordinated from supporting places of worship, hospitals and other health service
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organizations to enhance access to the Clinic.
Clinic Location and Facilities
Harmony Health Clinic’s need for a physical facility to commence operations is
paramount. Ideally we will be situated in a location which will strike a balance between being
accessible to both the concentration of those who we intend to serve, as well as the population of
the health care professionals who will render these services. It is likewise important that the
location be as close as possible to interstates, bus routes and other forms of public transportation,
as well as local hospitals and physicians’ and dentists’ offices for purpose of laboratory testing
and referrals. Of course, the initial site and size of the facility may change as the needs of the
Clinic change.
In any event, the Clinic will need, at a minimum, a physical location containing multiple
examination rooms, a basic laboratory, a secure drug storage space, a clean central supply, a
secure space for medical records, an intake room, a meeting room and/or office space, and a
reception area with (ideally) a dedicated area for the children of adult patients. Dental care may
also present special plumbing needs which will be taken into consideration.
Volunteer Screening, Training, and Protection
Quality medical care begins with skilled, experienced and caring professionals. A
number of actively-practicing and retired physicians, dentists, nurse practitioners, physician
assistants, nurses and other health care professionals have already expressed a high degree of
interest in volunteering to serve at Harmony Health Clinic. In addition, a multitude of lay
individuals have expressed their desire and willingness to help with Clinic operations in nonmedical capacity.
All volunteer medical professionals will be screened to assure that they have the
appropriate credentials, licenses and continuing education necessary to practice safely and with a
high degree of professionalism. Moreover, all volunteers—both medical and non-medical—will
receive training and orientation prior to beginning their service at the Clinic in order to maintain
a safe environment, high quality medical care, and a caring atmosphere for all patients visiting
the Clinic.
Harmony Health Clinic will participate in and comply with the Free Clinic Federal Tort
Claims Act (FTCA) Medical Malpractice Program described in Section 194 of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA), the effect of which will provide
the Clinic’s volunteer health care professionals with immunity from medical malpractice
lawsuits resulting from their subsequent performance of medical, surgical, dental or related
functions within the scope of their work at the free clinic. In other words, claimants alleging acts
of medical malpractice by the volunteer health care professional will be required to file any
claims against the United States of America (as opposed to against the volunteer individually),
and payment of any claim is subject to Congressional appropriations for the program.
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Moreover, the Clinic will register with the Arkansas State Board of Health and comply
with the requirements necessary to ensure that its volunteer licensed health care professionals,
and volunteer students acting under their supervision, are granted immunity (absent gross
negligence or willful misconduct) from civil damages for medical care rendered at free or lowcost clinics, i.e., Harmony Health Clinic, pursuant to the Arkansas Volunteer Immunity Act (as
amended and expanded in 2007).
Finally, as an extra layer of protection and degree of peace of mind for the Clinic’s
volunteer health care professionals, appropriate but low-cost malpractice insurance may be
obtained by the Clinic as well in addition to any coverage that may already exist under the
individual health care professional’s own insurance policy.
V.
NEEDS ASSESSMENT/MARKET ANALYSIS
The Problem: Lack of Access to Health Care
While our community continues to grow and prosper, there are many among us who, for
various reasons, are either left out of the healthcare system or seem to simply fall through the
cracks. Healthcare costs continue to spiral upward, leaving many in our county either without
medical insurance or the ability to pay for needed medical procedures. Some residents may have
lost their jobs and their healthcare coverage in the process. As citizens of Central Arkansas, we
can either turn our backs on those who are suffering from a lack of medical attention or join
together to minimize their illness and hardship. Through our organized efforts, we can alleviate
the silent suffering of many and exemplify the caring community we are.
The continuous rise in the cost of health care affects those with and without insurance.
Those with insurance have seen a disproportionate difference in growth between health insurance
premiums and worker earnings. In 2006, there was a 7.7 increase in the cost of health care. This
seemingly small increase was still over twice the rate of inflation.1 The total cost of health
insurance for individuals rose to $4,242 a year, and $11,480 a year for families in employerbased plans.2 The United States has spent twice the dollar amount on health care as compared to
the median industrialized nation.3 For people with insurance, the rising costs meant that more
money must be paid in premiums and deductibles as insurance companies shift the cost to the
consumer. Unfortunately, people without insurance have lacked the cushion of an insurance
company to assist with payments. Uninsured persons have been required to pay out-of-pocket
before receiving health related services. As health care becomes more expensive, more and more
people have lost insurance, had lapses in insurance coverage, and have forgone seeking
necessary medical care.
The Kaiser Family Foundation (KFF) estimates that for a near-poor family, 24 percent of
a worker’s earnings are left to cover expenses outside of housing, food and transportation.4
These expenses include clothes, education, utility bills, etc. Assuming a family four brings in
$30,000 annually, $7,200 is left to cover expenses other than housing, food and transportation.
The $30,000 is approximately 150% of the Federal Poverty Level (FPL). If the family is
enrolled in an employer-based family coverage plan, their contribution is $2,713. If the family is
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enrolled in a non-group plan, then their annual premium is $4,356.5 Deducting this amount from
the $7,200 left for expenses could lead to some families being uninsured.
In order to pay for health care, some people use credit cards to pay the debt, or use
personal savings accounts. Using a credit card to pay for services is dangerous because credit
cards with high interest make it very difficult to pay off a large balance. Also, using large
portions or all of person’s personal saving account diminishes the cushion for other unforeseen
bills that may arise. Paying out of pocket can be very expensive, especially if there is no
payment plan established or discounted services offered.
Persons who incur high amounts of medical debt are at risk of having to declare
bankruptcy. In 2002, there were 1.5 million bankruptcies filed, of which one third to one half
could be contributed to medical bills.6 One study categorized the average debtor as a forty-one
year old female with children and at least some college education.7 Medical bills could be in
excess of $1,000. A strong predictor of filing bankruptcy was a lapse in health care insurance
within two years prior to the filing.8 Lapses in insurance can come from changing jobs,
switching carriers, or being dropped by a carrier. When a person suffers from a chronic illness,
(s)he must find a way to continue to pay for medical care in order to manage the illness. This
means potentially having to cover office visits, tests, and medications out of his or her pocket
without insurance helping to cover part of the bill. It should be noted that people with health
insurance are not exempt from the threat of medical debt. One article asserts that twenty-nine
million people reported recent or accrued medical debt with an income of $40,000. Many of
these people had health insurance, but it may not have been sufficient. The same article also
asserts that 58 million people were at a risk of accruing medical debt that they would be unable
to pay.9 Eight percent of insured and twenty-three percent of uninsured people were contacted at
least once by a collection agency concerning their medical bills as reported by the KFF. 10
The consequences of declaring bankruptcy compound and complicate the financial
burden of both insured and uninsured persons. Bankruptcy on a credit report dramatically
reduces one’s credit score. This could have devastating effects when a person applies for loans
or other forms of insurance. Payment rates for vehicle insurance and mortgages are likely to be
higher for persons who have declared bankruptcy. The social aspect of declaring bankruptcy
could be disruptive enough that a person is turned down for a job. Being unemployed or
employed in a low wage job exaggerates the dilemma as the person may continue having trouble
paying bills and outstanding loans. If a person continues having trouble after declaring
bankruptcy, then (s)he may have to forfeit the collateral. This could mean losing a vehicle or a
house. One can easily see how losing either or both of these due to missed payments could
further set a person back. Bankruptcy is not a way out of debt, rather it is a sign that a person is
in much need of assistance that will probably not be provided.
A large group of people in America are at risk of not obtaining proper or adequate health
care. This group is collectively referred to as the uninsured. In 2005, there were about 46
million people living in the United States without some sort of health insurance, or about 15
percent of the population. This number seems to represent a relatively small percentage of the
total population, but there were 6 million less people uninsured during the year 2000. 11 The
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number of uninsured has continued to grow due to the type of health insurance system in
America. America has never implemented a universal health insurance system for its citizens
despite discussions in Congress. As early as the 1940s, Americans were interested in the idea of
a national health insurance plan. Since then, the system has remained a mix of federal, state,
employer-based and private insurance options. This mixed delivery system has allowed the
uninsured population to grow despite the taxes paid, programs developed, research conducted,
and discussions in Congress.
Uninsured people have tremendous potential to have unmet medical needs as a result of
inadequate health care. Lacking insurance alone or combined with other risk factors has been
shown to result in delayed medical care.12 The Institute of Medicine (IOM) estimates that
18,000 people die prematurely as a result of lacking health insurance.13 The longer a person
does not have health insurance, the more likely they are to report being in less than good
health.14 This may be due to insured and uninsured people’s nearly equal response that they
thought they needed care, but the insured were more likely to see or talk with a physician. About
82 percent of insured people spoke with a physician and were given care when they felt they
needed care, as compared to only 36.6 percent of noninsured people who spoke with a physician
and were given care when they felt the need.15
Lacking health insurance also places people at a disadvantage of accessing primary care.
When a person forgoes seeing a primary care physician, (s)he is less likely to receive adequate
preventive services and health management. Without health insurance, people have a difficult
time identifying a provider who provides affordable services.16 For those who seek care at a
safety net facility, about one quarter report being in debt to the facility, and therefore would not
seek care from the facility again.17 Dissatisfaction with services offered in safety net facilities
establish another barrier to receiving adequate preventive care. A person may visit several
different safety net facilities or avoid accessing care through the facilities.18 When a person
lacks a regular source of care, (s)he loses the continuity of care. The longer that a person waits
to obtain care if they are ill, the more likely they are to have worse physical health at the time of
examination. This could lead to the manifestation of other co-occurring health problems.
Improper management of a chronic illness in the early stages leads to more health problems as
the illness progresses. Therefore, late diagnosis of a chronic condition may lead to an earlier
death.
Thirty-seven percent of the uninsured population did not fill a prescription because of
cost.19 People who do fill prescriptions may cut pills in half, take fewer than the recommended
dose, or skip doses to make the medications last longer. Improperly managed use or misuse of
prescriptions puts a person at a greater risk of having a relapse in illness or inadequate treatment
of a chronic illness. Poor health status and multiple risk factors are associated with having more
unmet health needs and not having the needs properly cared for.20
The uninsured who do not receive preventive services are also more likely to be
hospitalized.21 Once hospitalized, the uninsured are more likely to receive substandard care.22
Being hospitalized further exaggerates the burden of payment for health care as services
administered in a hospital setting are more costly than if prevented altogether. The IOM also
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reports that hospitalized, uninsured people are more likely to not receive adequate services and
are at a greater risk of dying in the hospital or shortly after discharge. 23 Uninsured trauma
victims are less likely to be admitted and fully treated in the hospital.24
The use of hospitals and their emergency departments for non-urgent care has increased.
Emergency departments are accessible 24 hours a day, have the equipment to perform several
different tests, and do not require an appointment. However, the wait time can be extended for
those using the emergency room for non-emergent care. There was a 26% increase between
1993 and 2003 in emergency department visits.25 Of the 114 million visits in 2003, one-third
were classified as urgent and semi-urgent.26 Statistically, the use of emergency departments per
100 people has increased by 2.2 visits yielding a total of 38.2 visits per 100 people. 27 There are
twice as many uninsured versus insured people with chronic conditions that use the emergency
department for care.28 Emergency department visits have increased for people of all ages of
various ethnical backgrounds. People 65 years of age and over have the largest percentage of
persons that stayed at least one night in the hospital (8.1%).29 Also, as incomes decreased from
250% to 100% of the FPL, there was an increase in the number of persons who stayed at least
one night in the hospital (7.6% to 11.1% respectively).30 In contrast to the ever-increasing use of
the emergency department, there has been a decline in the number of facilities to handle the
growing need. There were 703 fewer hospitals, 198,000 fewer beds, and 425 fewer emergency
departments from the time span of 1993 to 2003.31 The fewer number of hospitals and
emergency departments add to the increased barrier access to care for the uninsured. Longer
waiting times are another result of fewer facilities.
The American Hospital Association (AHA) has defined uncompensated care as the
“overall measure of hospital care provided for which no payment was received form the patient
or insurer.”32 Uncompensated care is composed of a hospital’s combined bad debt and charity
care. Bad debt is debt for which a hospital was expecting payment for services, but never
received any payments. Charity care is when a hospital never expected any payment for services
rendered. Medicare and Medicaid reimbursements are excluded from the calculation. Different
hospitals and systems use different methods for classifying and identifying bad debt versus
charity care. Caution must be taken when considering the dollar amount charged to either
category of care.
The AHA reports that the total uncompensated cost of care has risen from $17.5 billion to
$28.8 billion from 1995 to 2005 for registered community hospitals.33 However, the number of
hospitals decreased from 5,166 in 1995 to 4,936 in 2005.34 The average percentage of total
expenses in uncompensated care varied between 5.4 and 6.1 percent with an average of 5.84%.35
Unfortunately there has been a decline in charity care provided through physician private
practices. One survey reports that less than one-forth of families with at least one insured family
member had received free or discounted services.36 The percentage of physicians that provide
charity care dropped from 76.3% in 1997 to 68.2% in 2005.37 The number of hours providing
charity care has decreased to 10.6 in 2005; a drop of 0.5 hours from 1997.38 Eighty percent of
private practice physicians provided charity care in 2005. But, the percentage of private practice
physicians has decreased from 40 percent to 31 percent, while the percentage practicing in
hospitals or large groups has increased from 21 percent to 26 percent. Physicians of all
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specialties working in large groups or hospitals are generally less likely to provide charity care
versus a private practice physician.
The effect of rising health care costs and decreased reimbursements may play a role in
the amount of charity care provided by private practice physicians. 75.6% of physicians with
incomes greater than or equal to $250,000 provided charity care in 2005. 39 However, only 66.4
percent of physicians with an income equal to or less than $125,000 provided charity care. 40 As
a result of lower reimbursements, more physicians will likely fall out of the $250,000 or more
annual earnings category, thereby making it more difficult for them to provide charity care. A
decline in charity care will increase the burden for the uninsured as they will be expected to pay
in full up front for physician services.
The Problem: Lack of Access to Health Care in Arkansas
A closer look at local data reveals that Arkansas experiences similar problems linked to
being uninsured. Specifically, the safety net system in Little Rock is composed of community
health centers and free clinics. The Arkansas Health Care Access Foundation has seen a sixty
percent increase in requests for assistance by uninsured Little Rock residents.41 An increase in
undocumented immigrants accessing health care resources has also placed pressure on the safety
net system.42 The number of Latinos that accessed the Jefferson Comprehensive Community
Care system increased from 40% from 2002 to 2005. Moreover, although health insurance
premium increases have been slower in Little Rock as compared to the nation, employersponsored insurance premiums are still costly as compared to incomes.43 This is due in part to
the number of small businesses in the metropolitan area that are unable to cover larger
percentages of the premiums. This cost is in turn shifted to the enrolled employees.
A new program commenced in January of 2007, ARHealthNet (www.arhealthnet.com),
has been designed and implemented by the State of Arkansas to help alleviate this problem, and
is partially funded through funds from Medicaid and Arkansas’ tobacco settlement to help small
businesses offer basic benefits to employees. The program focuses upon businesses that employ
2 to 500 employees and have not offered health insurance in the previous 12 months or longer.
Under this program, qualifying employees have access to inpatient and outpatient hospital care,
physician services, and pharmaceutical drug assistance. Enrollees are responsible for 15% of the
allowed service charges. However, dental and corrective vision services are not offered through
ARHealthNet, and according to a June 13, 2007 article in the Arkansas Democrat-Gazette only
536 people had enrolled in the program as of the end of May 2007.
Data has been gathered from two large providers of health care services for Pulaski
County, the University of Arkansas for Medical Science (UAMS) and Baptist Health. Both
systems provide care for those unable or unwilling to pay. One survey conducted in Little Rock
notes that “UAMS is the primary provider of emergency, inpatient and specialty services for the
uninsured in Little Rock and much of the state.”44 As noted, this type of care may be considered
charity care. UAMS provided approximately $53 million and $37.3 million in charity care for
2005 and 2004 respectively. UAMS categorized approximately $45,383,000 in 2005 and
$19,800,000 in 2004 for Medicaid reimbursements relating to Upper Payment Limit and
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Disproportionate Share. These types of reimbursements are available to state-operated teaching
hospitals. Also, UAMS provided $25,265,000 in 2005 and $25,810,000 in 2004 in services
under the Enhanced Medicaid program. Baptist Health systems served 50,501 inpatient and
420,942 outpatient and emergency room visits in 2004. Baptist Health provided $30,773,697 in
charity care for 2004. In addition, Baptist Health provided $572,574,898 for Medicare and
Medicaid services. These forms of insurance do not reimburse in full. Therefore, the total
amount of non-reimbursed care totaled $603,348,595 (or 40.2% of gross patient revenue) in
2004.
The high price of health care erects a barrier to access for the insured and uninsured.
Unfortunately, the people without insurance have a more difficult time accessing health care
when they need it. People with inadequate insurance experience similar problems with access to
services, especially if they have a lapse in coverage. A majority of Arkansans obtain their health
insurance through their employer, yet cost shifting has led to an increase in the amount that
employees must pay in premiums and deductibles under employer-sponsored insurance plans.
Some employees are forced to altogether abandon policies as a result of the gap between income
and cost of insurance. This contributes to the increasing numbers of uninsured Arkansans, which
are increasingly being cared for by the safety net system of community health centers and free
clinics.
The Statistics: What Difference Does The Lack of Access to Health Care Make in Our
Community?
—HEALTH INSURANCE MATTERS: Because there is a strong relationship between
health insurance and access to medical services, whether or not people have health
insurance directly impacts whether, when and where people obtain necessary medical
care, and ultimately how healthy people are45—it also has financial effects on families
and societal effects on our community46
—LACK OF INSURANCE AFFECTS ACCESS: For example, the uninsured are up to
three times more likely than those with insurance to report problems getting needed
medical care, even for serious conditions—over 40% do not have a regular place to go
when they are sick or need medical advice, compared to just 9% of those with
coverage—approximately 20% of the uninsured report that their usual source of care is
an emergency room47
—DELAYED OR SACRIFICED CARE: In 2003, nearly half of uninsured adults
postponed seeking medical care, and over a third said that they needed medical care but
did not get it—48Anticipating costly medical bills, many of the uninsured are not able to
follow the recommended treatment, i.e., over a third of uninsured adults state that they
did not fill a drug prescription in the past year and over a third went without a
recommended medical test or treatment due to cost49
—AVOIDABLE HEALTH PROBLEMS: Because uninsureds are less likely than
insureds to have regular outpatient care, they are more likely to be hospitalized for
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avoidable health problems—when they are hospitalized they are more likely to receive
fewer services and to die in the hospital than are insured patients50
—PREVENTATIVE CARE: The uninsured are also less likely to receive timely
preventative care—for example, insured nonelderly adults are at least 50% more likely to
have had preventative care such as pap smears, mammograms and prostrate exams
compared to uninsured adults51—because people with insurance are significantly more
likely to have had cervical, breast and colon cancer screenings, uninsured cancer patients
are diagnosed in later stages of the disease and die earlier than those with insurance52
—MORTALITY RATES: Having insurance improves health overall and could reduce
mortality rates for the uninsured by 10-15%53—the Institute of Medicine estimates that at
least 18,000 Americans die prematurely each year solely because they lack health
coverage54
—FAMILIES’ FINANCIAL WELL-BEING: Insurance helps reduce the financial
uncertainty associated with health care, as illness and health care needs are not always
predictable and care can be very expensive. Those lacking coverage are therefore more
financially vulnerable to the high cost of care, are exposed to higher out-of-pocket costs
compared to the insured, and are more often burdened by medical bills55—Over a third of
the uninsured have a serious problem paying medical bills, and nearly a quarter are
contacted by collection agencies for medical bills56
—SOCIETAL EFFECTS: Lack of health care exacts an indirect toll on society in terms
of more disability, lower productivity, and an increased burden on the health care
system57
The Statistics: How Many Americans and Arkansans Lack Health Insurance?
—AMERICANS: The majority of Americans (62%) under the age of 65 receive health
insurance coverage through their employers and almost all of the elderly are covered
through Medicare—Medicaid and the State Children’s Health Insurance Program
(SCHIP) cover millions of nonelderly low-income people, especially children58
—In 2000, approximately 39.6 million Americans did not have health insurance
and by 2004, that number had climbed to approximately 45.5 million
Americans59—Now more than one in six of the nonelderly population are
uninsured (18%)60
—Depending upon whether one counts the number of people who are uninsured
during a specific month, for an entire year, or just for short periods, experts agree
that on any given day of the year the number of uninsured is now about 45
million—the number of people ever uninsured over the course of a year is much
greater than 45 million, by as much as 40%61
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—ARKANSANS: In 2001, approximately 392,000 Arkansans did not have health
insurance, i.e., 15% of the population—However, by 2004 approximately 456,000
Arkansans did not have health insurance, i.e., 17% of the population62
—Through federal, state and private programs, approximately 9 out of 10 (89.6%)
Arkansas children (0-18 years) have health insurance, and more than half of all
children received coverage from the state’s Medicaid program, ARKids First, in
200463
—Medicare covered virtually all (98.5%) elderly (65+ years) Arkansas
adults in 200464
—However, only 3 out of 4 (75.6%) working-age (19-64) adults had
insurance in 200465
The Statistics: Who Are Our Uninsured Neighbors?
—EMPLOYMENT: In 2004 the majority (61%) of the uninsured were working in either
full-time (45%) or part-time (16%) jobs66. Nationwide in 2003, over 8 in 10 uninsureds
came from working families, 70% from families with one or more full-time workers and
12% from families with part-time workers (only 19% of the uninsured are from families
that have no connection to the workforce)67
—In Arkansas, 92.9% of private employers with 50 or more employees offered
health insurance; however, only 25.7% of businesses with less than 50 employees
offered health insurance68. When Arkansas employers offered health insurance
benefits to their employees, most (78%) employees purchase it
—EARNINGS: In 2004 more than one-fourth (26%) of Arkansans with family incomes
below $19,000 (100% of the Federal Poverty Level [“FPL”] for a family of 4) did not
have health insurance coverage; the same (26%) was true for Arkansas families who
earned between $19,000 and $38,000 (100-200% of the FPL for a family of 4).
Significantly, more than half of all Arkansas families make less than $35,000 annually69
—In Arkansas, children in low-income families (<200% FPL) qualify for
Medicaid and most of these children are insured—however, low-income workingage adults do not qualify for Medicaid unless they are also disabled and have
limited financial assets; almost one-half (46%) of Arkansans between 19 and 64
years of age with family incomes less than 100% of the FPL were uninsured in
200470
—EDUCATIONAL ATTAINMENT: Nationally, adults who have not graduated from
high school are about twice as likely to be uninsured as those with a high school diploma
(40.2% vs. 20.3%). Having a college degree is strongly associated with multiple factors
that increase the likelihood of being insured, such as employment in sectors more likely
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to offer coverage, higher income, and a greater likelihood of choosing employment-based
coverage if it is offered
—GENDER AND AGE: Among Arkansans without health insurance, approximately
50% were males and 50% were females: 10% of uninsured Arkansans were between 0-18
years old, 30% were between 19-44 years old, 17% were between 45-64 years old, and
2% were 65 years or older71
—ETHNICITY: In 2004, 15% of Caucasian Arkansans had no health insurance, 17% of
African-American Arkansans had no health insurance, 39% of Hispanic Arkansans had
no health insurance, and 22% of Arkansans who are members of other ethnic groups had
no health insurance
—Within virtually all ethnic groups in Arkansas in 2004, the uninsured were
concentrated in the 19-64 year-old age group; specifically, 1 out of 5 (20%)
Whites, 1 out of 4 (25%) African-Americans, and 1 out of 2 (49%) Hispanics in
the 19-64 year old age group did not have health insurance
—IMMIGRATION STATUS AND NATIVITY: The foreign born population in the
United States is almost three times as likely to be uninsured as the native born population.
Among the foreign born, citizens are almost twice as likely as non-citizens to have health
insurance. With exceptions, i.e., those needing emergency care and refugees, all legal
immigrants who arrive in the U.S. after August 1996 are barred from participation in
public health insurance programs (Medicaid and SCHIP) for their first five years of
residency in the country, and this prohibition adds to the discrepancy in insurance rates
between the native and foreign-born populations
The Statistics: Pulaski County, Arkansas Demographics In Particular
The United States Census Bureau has released the 2005 profile data for Pulaski County,
Arkansas. The information contained data concerning demographics, social structure, economic
structure and the housing structure for Pulaski County residents. The following summaries and graphs
will help demonstrate that a sizable percentage of the Pulaski County, Arkansas will benefit from
Harmony Health Clinic.
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Population
In 2005, the population of Pulaski County was 358,234 persons. Of this population, fifty-two
percent of the population was female (187,626) and forty-eight percent was male (170,606).
Age Distribution
12%
22%
19 and under
20 to 64
65 and over
66%
Source: U.S. Census Bureau, Census 2005 Data Profile
As shown by the graph, persons aged 20 to 64 make up the largest percentage of the population
in Pulaski County. The total number of persons in this age group is 217,721. The median age is
36.2 years of age. Of the total population for Pulaski County, twelve percent, or 40,861 persons,
are at the age to be eligible for Medicare. The Kaiser Family Foundation reports that 13.7 % of
Arkansans were covered by Medicare between the years 2004 to 2005.
Ethnicity
The ethnic breakdown of Pulaski County shows that there are 227,030 White persons in the
county. African-Americans total 123,873 persons. Hispanics or Latinos of any race total
11,486 persons. Asians of any race total 6,710 persons, American Indian and Alaska Native
persons equal 3,595. The remainder of persons reporting one race total 6,143 persons. The
ethnicity of Pulaski County is summed up in the following chart.
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Ethnicity/Racial Background
Some other race
2%
Asian
2%
American Indian and Alaska
Native
1%
Hispanic or Latino (of any
race)
3%
Black or African American
33%
White
59%
White
Black or African American
Hispanic or Latino (of any race)
American Indian and Alaska Native
Asian
Some other race
Source: U.S. Census Bureau, Census 2005 Data Profile
As seen, the majority of Pulaski County’s population is comprised of White and AfricanAmericans. Hispanics, Asians, American Indians and other races only make up eight percent of
Pulaski County’s population.
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Foreign Born Populatoin
16,000
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
Series1
Foreign-born population
Naturalized U.S. citizen
Not a U.S. citizen
14,635
4,950
9,685
Source: U.S. Census Bureau, Census 2005 Data Profile
The bar chart shows the distribution of citizens and non-citizens in Pulaski County. The 14,635
foreign born persons account for 4% of Pulaski County’s population.
Language
The language spoken in most homes by persons aged 5 years or older is English. Spanish is the
second most spoken language in the home. The distribution of languages spoken can be seen in
the chart and table below.
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Languages Spoken in Home
English only
Spanish
Other Indo-European languages
Asian and Pacific Islander languages
Other languages
Languages spoken in the home and number of persons speaking specific language:
English only
Spanish
Other Indo-European languages
Asian and Pacific Islander languages
Other languages
310,063
10,800
5,037
2,993
1,001
Source: U.S. Census Bureau, Census 2005 Data Profile
Households
The average household size for Pulaski County is 2.34 persons. Families make up 62 percent of
the households in Pulaski County. Married couples comprise 41 percent of total households for
the county. Male households with no wife present and female households with no husband
present comprise the remaining 21 percent of the county’s households. The remaining 38
percent of nonfamily households is mostly comprised of persons living alone. The total
percentage of persons living alone in a nonfamily home equals 87 percent. Twenty percent of
Pulaski County’s population is comprised of persons 60 years of age and over living alone in a
nonfamily setting. The following chart and diagram help visualize the numbers.
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Households
160,000
140,000
120,000
100,000
Households
80,000
60,000
40,000
20,000
0
Series1
Total Households
Family
households
Married-couple
families
153,043
95,276
63,449
Male
Female
householder, no householder, no
wife present
husband present
6,568
Type
Source: U.S. Census Bureau, Census 2005 Data Profile
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25,259
Nonfamily
households
57,767
Nonfamily Households
60,000
50,000
40,000
30,000
20,000
10,000
0
Series1
Nonfamily households
Householder living alone
65 years and over
57,767
50,295
11,797
Source: U.S. Census Bureau, Census 2005 Data Profile
Education
The educational attainment for Pulaski County residents aged 25 and over equals 236,494
persons. Eighty-nine percent of those with an education are high school graduates or higher.
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Educational Attainment
11%
12%
20%
27%
< 9th grade to 12th grade, no diploma
High school graduate (includes equivalency)
Some college, no degree
Associate's degree
Bachelor's degree
Graduate or professional degree
6%
24%
The following chart represents the number of persons in Pulaski County with differing levels of
education. These numbers were used to make the pie chart above.
< 9th grade to 12th grade, no diploma
High school graduate (includes
equivalency)
Some college, no degree
Associate's degree
Bachelor's degree
Graduate or professional degree
25,676
66,055
55,673
14,635
47,149
27,297
Source: U.S. Census Bureau, Census 2005 Data Profile
Workforce Structure
Pulaski County has a high number of persons eligible to work in the workforce. Total persons
not in the workforce equal 90,665 persons or 32.9% of the eligible working population. The
graph below shows the distribution of persons employed, unemployed, and not in the workforce.
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Pulaski County workforce
300,000
250,000
200,000
150,000
100,000
50,000
0
Series1
Population 16 years
and over
In labor force
Employed
Unemployed
Not in labor force
275,325
184,660
171,210
11,102
90,665
Source: U.S. Census Bureau, Census 2005 Data Profile
Communication by workforce
The following pie chart shows the means of communication for those in the workforce. The
number of people who drive their own vehicle or carpool greatly outnumbers the number of
people who use public transportation.
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Means of Travel to Work
896
2,211
1,608
18,156
Car, truck, or van -- drove alone
Car, truck, or van -- carpooled
Public transportation (excluding taxicab)
Walked
Other means
140,748
Source: U.S. Census Bureau, Census 2005 Data Profile
Income
Pulaski County has 14.3% of its population below the poverty line. Of that percentage, the
number of persons under 18 years of age accounted for 22.1%. Persons aged 18 to 64 years
accounted for 12.3% of the population below the poverty line. Persons aged 65 years and over
accounted for 7.7% of the population below the poverty line. The data can be seen in the bar
chart below.
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Age Distribution of All Persons Below Poverty Line
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Under 18 years
18 to 64 years
65 years and over
Source: U.S. Census Bureau, Census 2005 Data Profile
Families had a higher median income when compared to nonfamily homes. The median income
for a family was $52,339. For nonfamily homes, the median income was $25,183. Nonfamily
homes’ median income was 48% of family homes.
Uninsureds
The 2000 Census data reports an estimate of 52,197 uninsured persons of all ages in Pulaski
County. That accounted for 14.5% of the county’s population in 2000. The Behavioral Risk
Factor Surveillance System (BRFSS) reported 36,779 persons over 18 years old had no insurance
in Pulaski County during 2005. This accounted for 13.5% of the 272,437 persons aged 18 or
older in Pulaski County. For children under the age of 18, there were 11,560 uninsured persons
(US Census Bureau, 2000). That equaled 12.4% of Pulaski County’s population.
In 2004, the Pulaski County Hometown Health organization and the Arkansas Department of
Health conducted the Adult Health Survey to gather information concerning health risk factors.
One question focused on access to health insurance. The question presented to participants was
“Do you have any kind of health care coverage, including health insurance, prepaid plans such as
HMOs, or government plans such as Medicare?” If the person answered “no,” they were
categorized as at risk. The responses of the 838 participants can be seen in the following graph.
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The responses were grouped according to age of the participant, education level and income
level.
Groups At Risk of Not Having Health Insurance
65+ y/o
40-64 y/o
18-39 y/o
HS Grad or less
College Grad
less than $50K
$50K and over
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Source: Pulaski County Hometown Health & The Arkansas Department of Health, 2004 North Pulaski County community adult health survey:
Maumelle, Jacksonville, and Sherwood Behavioral Risk Factor Surveillance System.
Risk Factors for Pulaski County
The Arkansas Center for Health Statistics (ACHS) comprised the 2005 County BRFSS. ACHS
had 272,437 respondents over the age of 18 complete the survey in Pulaski County. of the
respondents, 13.2% did not have a personal doctor as compared to 17.1% for the state. No
national BRFSS statistic was available for comparison. For women aged 18 and older in Pulaski
County, 17.5% had not had a Pap smear in the previous 3 years compared to 20.1% for the state.
Women aged 40 and older reported 25.6% had not had a mammogram in the previous 2 years as
compared to 28.9% for the state. Persons aged 65 and older were asked if they ever had a
pneumonia shot. For Pulaski County, 40.5% reported never having a shot, which is lower than
the state average of 42.6%, but higher than the national average of 34.1%. The survey reported
that 21.3% of Pulaski County residents currently smoke. That figure is below the state average
of 23.5%, but higher than the national average of 20.6%. A factor that Pulaski County reports a
higher percentage than the state and national average is flu shot vaccinations for persons aged 65
and older. Thirty-five point seven percent (35.7%) of those surveyed had a flu shot in the
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previous year, whereas only 34.8% of the state and 34.3% of the nation had a flu shot. Fruit and
vegetable consumption was higher for Pulaski County (77%) than the state (74.3%), but lower
than the national percentage (79.7%). Exercise among Pulaski County (27.2%) was lower than
the state (30.6%), but higher than the national percent (23.8%). There are fewer people in
Pulaski County with diabetes (7.7%) than the state (8.0%), but more than the national percentage
(7.3%). Arthritis is less prevalent in Pulaski County (29.2%) than the state (30.7%), but higher
than the national percent (27.0%). Hypertension in Pulaski County is reportedly lower (27.6%)
than the state percentage (29.0%), but higher than the national reported percentage (25.5%). The
reported numbers for high cholesterol are higher in Pulaski County (36.2%) versus the state
(32.9%). However, the percentage in Pulaski County is lower than the national percentage of
persons with high cholesterol (39.5%). As can be seen from the figures, Pulaski County ranks
better than the state on most risk factors, but is still above the national percentages.
References
Pulaski County Hometown Health & The Arkansas Department of Health. (2004). 2004
North Pulaski County community adult health survey: Maumelle, Jacksonville, and
Sherwood Behavioral Risk Factor Surveillance System. Little Rock, AR: Author.
U.S. Census Bureau. (2000). Small area health insurance estimates: Model-based
estimates for counties and states.
Retrieved October 14, 2006, from
http://www.census.gov/hhes/www/sahie/data.html.
U.S. Census Bureau. (2005). Pulaski County, AR 2005 data profile. Retrieved October
12, 2006, from http://factfinder.census.gov.
The Statistics: The Pool of Potential Medical Volunteers
According to the Arkansas State Medical Board, in 2004 their registry included 5,174
medical doctors (about one per 10,000 population), 2,027 of whom were located in Pulaski
County. 756 of these physicians were registered in the five primary care specialties (family
practitioners, general practitioners, internists, obstetrics-gynecologists, pediatricians) and 1,254
were registered in a secondary specialty.
In 2004 the Arkansas Board of Dental Examiners licensed 2,107 providers of dental
health services with mailing addresses in Arkansas, about 8 per 10,000 population. The Board
also issued permits to 2,447 dental assistants. 240 of the dentists were located in the Little Rock
area.
The Arkansas Board of Pharmacy licensed 2,671 status A (active) pharmacists, about 10
per 10,000 population, with mailing addresses in Arkansas. 658 of these pharmacists were
located in Pulaski County.
In 2004 the Arkansas Optometry Licensing Board licensed 320 optometrists with mailing
addresses in Arkansas. 45 of these optometrists were located in Pulaski County.
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Finally, in 2004 the Arkansas Nursing Board licensed 42,104 nurses with mailing
addresses in Arkansas, about 155 per 10,000 population. This includes 25,442 registered nurses
(RN), 14,448 licensed practical nurses (LPN), and 308 licensed psychiatric technician nurses
(LPTN). Of the registered nurses, 1,906 were licensed for advanced practice nursing. Of the
total number of nurses practicing in Arkansas, 6,854 were located in Pulaski County, and 5,193
were RN’s, 1,567 were LPN’s, and 94 were LPTN’s.
Existing Local Charitable Health Clinic Resources
There are a number of charitable health clinics operating in the State of Arkansas, all of
which have different eligibility requirements, offer an array of different levels of services, and
are open on different days and at different times during the week. Many of these clinics are
members of the Arkansas Association of Charitable Clinics, a non-profit corporation based in
Hot Springs, whose mission is to serve as an advocate for member charitable clinics and the
populations they serve, and whose vision is to be a collaborative network to improve access to
compassionate health care for the underserved people of Arkansas. The member charitable
clinics as of April 2007 are listed below, but even their tremendous efforts has not stemmed the
ever-increasing and already-overwhelming numbers of Arkansans who live and work everyday
without access to quality health care. Harmony Health Clinic is eager to join, as soon as
possible, the following entities already operating across Arkansas in order to address this
troubling societal problem in the Greater Little Rock area:
---Baptist Health Community Wellness Centers
Opened June, 1996
(Beebe/Heber Springs/Little Rock/North Little Rock/
Lonoke/Quitman/Sherwood)
---Charitable Christian Medical Clinic
Opened March 5, 1998
(Hope)
---Charitable Christian Medical Clinic
Opened January 28, 1997
(Hot Springs)
---Christian Community Care Clinic
Opened September 13, 1999
(Benton)
---Christian Health Center
Opened February, 1998
(Heber Springs)
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---Christian Health Center of Howard County, Arkansas
Opened February 22, 2007
(Searcy)
---Conway County Christian Clinic
Opened May 18, 2004
(Morrilton)
---Conway Interfaith Clinic
Opened October 22, 2003
(Conway)
---Eureka Christian Health Outreach
Opened November 10, 2005
(Eureka Springs)
---Good Samaritan Clinic
Opened July 15, 2003
(Fort Smith)
---Grand Prairie Charitable Christian Medical Clinic
Opened April 3, 2001
(DeWitt)
---Interfaith Clinic
Opened May 23, 1995
(El Dorado)
---Jonesboro Church Health Clinic
Opened 1992
(Jonesboro)
---Mountain Home Christian Clinic
Opened April 27, 2000
(Mountain Home)
---Ninth Street Ministries Free Clinic
Opened 1998
(Mena)
---Northwest Arkansas Free Health Center
Opened 1986
(Fayetteville)
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---Pine Street Free Clinic
Opened December 2, 2002
(Conway)
---River City Ministry
Opened January 1994
(North Little Rock)
---River Valley Christian Clinic
Opened January 11, 2007
(Dardanelle)
---Rotary Centennial Dental Clinic
Opened March 2, 2004
(Harrison)
---Samaritan Dental Clinic
Opened April 18, 2006
(Rogers)
---Shepherd’s Hope Neighborhood Health Center
Opened July 27, 2006
(Little Rock)
---St. Vincent Community Clinics
Opened Fall, 1999
(Little Rock/North Little Rock)
---Westside Free Medical Clinic
Opened 1972
(Little Rock)
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VI. FINANCIAL AND FUNDRAISING PLAN
Start-Up Budget and Two-Year Operating Budget
INCOME
Start-Up
Year 1
Year 2
Grants (Private)
Grants (Government)
Hospitals/Health Care Providers
Business/Corporate
Churches/Synagogues/Temples
Civic Groups
Individual Donors
Miscellaneous (Fundraisers, etc.)
$250,000
$20,000
$50,000
$50,000
$20,000
$5,000
$30,000
$10,000
$100,000
$20,000
$50,000
$50,000
$25,000
$10,000
$40,000
$20,000
$100,000
$20,000
$50,000
$70,000
$30,000
$10,000
$50,000
$30,000
TOTAL INCOME
$435,000
$315,000
$360,000
EXPENSES
Start-Up
Year 1
Year 2
$0
$0
$110,000
$12,000
$120,000
$14,000
$0
$500
$500
$0
$0
$0
$250,000
$75,000
$1,000
$2,000
$1,000
$2,000
$1,000
$5,000
$4,500
$1,000
$0
$0
$2,000
$1,000
$7,500
$2,000
$1,500
$35,000
$22,000
$2,000
$10,000
$0
$3,000
$0
$5,000
$5,000
$4,000
$2,500
$5,000
$6,000
$4,000
$10,000
$15,000
$5,000
$5,000
$5,000
$6,000
$2,000
$5,000
$2,000
$2,500
$35,000
$24,000
$2,000
$10,000
$0
$3,000
$0
$10,000
$10,000
$6,000
$5,000
$5,000
$6,000
$6,000
$12,000
$25,000
$5,000
$7,500
$7,500
$10,000
$3,000
$5,000
$2,000
$3,000
$35,000
Salaried Staff Positions
Payroll Taxes
Employee Benefits/Health
Insurance
Directors & Officers Insurance
Property Insur./Worker’s Compens.
Malpractice Insurance
Janitorial/Maintenance Services
Mortgage/Rent
Renovations (Building/Equipment)
Office Equipment/Repairs#
Office Supplies
Medical/Dental Chart Supplies
Volunteer Supplies
Alarm/Utilities
Telephone/Internet Expenses
Medical/Dental Supplies
Pharmaceuticals
Accounting Fees
Laboratory Expenses
Radiology Expenses
Postage
Copier/Printing/Facsimile
Promotion/Development
Travel Expenses
Education
Professional Expenses
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Dues/Subscriptions
Miscellaneous Expenses*
TOTAL EXPENSES
$3,500
$39,000
$4,000
$28,000
$4,000
$20,000
$435,000
$315,000
$360,000
# Includes computers and software purchases, tables, chairs, exam tables, etc.
*Examples of Miscellaneous Expenses include: Signage (external and internal), millwork,
electricity, plumbing, heating/cooling system upgrades, toys for child care area, magazines,
water cooler, cups/plasticware, etc. In addition, reserves or contingency funds will be created
from remaining monies.
Funding Requirements
In summary, Harmony Health Clinic needs:
---$ 435,000 for start-up expenses
---$ 315,000 for 1st year funding
---$ 360,000 for 2nd year funding
Fundraising and Development Efforts
Potential sources for funds for start-up, capital projects, and ongoing expenses include:
---Grants from private foundations, both local and national
---Grants from local, state and federal government
---Churches, synagogues, and temples
---Civic groups
---Businesses and corporations
---Local hospitals and health care providers
---Individual donors
Harmony Health Clinic’s Development/Fundraising Committee will oversee efforts in
each of the above areas, and direct ongoing fundraising efforts to continually support operating
expenses and expand services throughout the community. Clinic representatives have already
spoken with, and will continue to meet with, officials from other charitable clinics to determine
which types of development efforts have proven most successful. The Clinic’s Media/Public
Relations Committee has already taken steps to produce a website and other materials (brochure,
Powerpoint presentation, etc.) to assist in spreading word regarding the Clinic’s existence,
mission, needs, and the federal and state tax advantages of making gifts to this effort.
The first approach will be to, through the efforts of the Board of Directors and its
Members, develop a database of individual donors who will be addressed personally or by direct
mail. The Clinic’s hope is that this will help generate both start-up funds and a resource to
expand potential donors. The Clinic will immediately develop both similar and different
approaches to seek donations from private foundations; government; hospitals and health care
providers; businesses and corporations; churches, synagogues, and temples; civic groups; and
-4444
other potential funding sources. If the need arises Harmony Health Clinic may at some point
elect to retain the services of a professional solicitor or grant writer on a contingency fee basis.
In addition to general fundraising efforts, the Development/Fundraising Committee will develop
a plan to generate in-kind donations of medical equipment and supplies. It is anticipated that
periodic fundraisers such as banquets, silent auctions, golf tournaments, annual dinners, and the
like will also be utilized to both raise funds and awareness.
The Development/Fundraising Committee will also be responsible for formulating, and
lining up professionals to assist with, a formal plan to coordinate receipt of gifts such as:
---large cash donations;
---securities/stocks and bonds;
---personal property such as art, manuscripts, literary works, vehicles and current
computer hardware or business equipment/supplies;
---conveyances of real estate; and
---estate planning gifts such as retirement plan assets, life insurance proceeds, and
bequests from wills and trusts.
Finally, programs will be developed for donors who wish to make gifts to the Clinic in honor or
in memory of loved ones, as well as for those individuals and entities who might elect to make
significant donations in exchange for the right to forever “name” certain areas of the Clinic
(pharmacy, reception area, examination rooms, parking lot, facility as a whole, etc.)
Accounting
Harmony Health Clinic will comply with strict internal control procedures in order to
operate with full accountability and earn the confidence of its valued supporters. Experienced
accountants will volunteer their services and all financial statements will be audited by an
outside accounting firm. The Clinic anticipates following a “cash-basis” method for its
accounting practices and procedures.
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REFERENCES CITED
1
(The Associated Press, 2006)
2
(The Associated Press, 2006)
3
(Davis, 2007)
4
(Kaiser Commission on Medicaid and the Uninsured, 2006)
5
(Hoffman, 2007)
6
(Himmelstein, Warren, Thorne, & Woolhandler, 2005)(Levine, 2007)
7
(Himmelstein, Warren, Thorne, & Woolhandler, 2005)
8
(Himmelstein, Warren, Thorne, & Woolhandler, 2005)
9
(Seifert & Rukavina, 2006)
10
(Kaiser Commission on Medicaid and the Uninsured, 2006)
11
(Hoffman, 2007)
12
(Shi & Stevens, 2005)
13
(Institute of Medicine, 2002)
14
(Alliance for Health Reform, 2006)
15
(Alliance for Health Reform, 2006)
16
(Weinick, Byron, & Bierman, 2005)
17
(Weinick, 2005)
18
(Kahn, Tumiel-Berhalter, Cadzow, Watkins, Leonard, & Taylor, 2007)
19
(Kaiser Commission on Medicaid and the Uninsured, 2006)
20
(Shi & Stevens, 2005)
21
(Kahn, Tumiel-Berhalter, Cadzow, Watkins, Leonard, & Taylor, 2007), (Hoffman, 2007)
22
(Hoffman, 2007)
23
(Institute of Medicine, 2002)
24
(Institute of Medicine, 2002)
25
(Cunningham, What Accounts for Differences in the Use of Hospital Emergency Departments Across
U.S. Communities, 2006), (Institute of Medicine, 2002)
-4646
26
(Cunningham, What Accounts for Differences in the Use of Hospital Emergency Departments Across
U.S. Communities, 2006), (Institute of Medicine, 2002)
27
(Clancy, 2007)
28
(Davis, 2007)
29
(Bandari, 2006)
30
(Bandari, 2006)
31
(The Institute of Medicine, 2006)
32
(American Heart Association, 2006)
33
(American Heart Association, 2006)
34
(American Heart Association, 2006)
35
(American Heart Association, 2006)
36
(Hoffman, 2007), (Kaiser Commission on Medicaid and the Uninsured, 2006)
37
(Cunningham & May, A Growing Hole in the Safety Net: Physician Charity Care Declines Again, 2006)
38
(Cunningham & May, A Growing Hole in the Safety Net: Physician Charity Care Declines Again, 2006)
39
(Cunningham & May, A Growing Hole in the Safety Net: Physician Charity Care Declines Again, 2006)
40
(Cunningham & May, A Growing Hole in the Safety Net: Physician Charity Care Declines Again, 2006)
41
(Katz, Grossman, Hurley, May, Nichols, & Strunk, 2005)
42
(Katz, Grossman, Hurley, May, Nichols, & Strunk, 2005)
43
(Katz, Grossman, Hurley, May, Nichols, & Strunk, 2005)
44
(Katz, Grossman, Hurley, May, Nichols, & Strunk, 2005)
Sources For The Above Citations
(Special thanks to Mark Chu, a graduate student and now-medical student at the University of Arkansas for Medical
Sciences, for his research and compilation of much of the information in this document)
Alliance for Health Reform. (2006, March). Cover the Uninsured. Retrieved August 8, 2006, from
http://covertheuninsured.org/materials/files/2006/HealthCareCoverageinAmerica.pdf
American Heart Association. (2006). AHA Uncompensated Hospital Care Cost Fact Sheet.
Bandari, S. (2006). Health Status, Health Insurance and Health Services Utilization: 2001. Washington,
DC: U.S. Census Bureau.
-4747
Clancy, C. M. (2007). Emergency Department in Crisis: Opportunities for Research. Health Research and
Educational Trust , 42 (1), 13-20.
Cunningham, P. J. (2006, July 18). What Accounts for Differences in the Use of Hospital Emergency
Departments Across U.S. Communities. Health Affairs , 324-336.
Cunningham, P. J., & May, J. H. (2006). A Growing Hole in the Safety Net: Physician Charity Care
Declines Again. Center for Studying Health System Change, Washington, DC.
Davis, K. (2007). Uninsured in America: problems and possible solutions. BMJ , 334, 346-349.
Himmelstein, D. U., Warren, E., Thorne, D., & Woolhandler, S. (2005, February 2). Illness and Injury as
Contributors to Bankruptcy. Health Affairs , 65-73.
Hoffman, C. B. (2007). Simple Truths About America's Uninsured. American Journal of Nursing , 70 (1),
40-47.
Institute of Medicine. (2002, May 21). Care Without Coverage: Too Little Too Late. Retrieved February
17, 2007, from http://iom.edu/CMS/3809/4660/4333.aspx
Kahn, L. S., Tumiel-Berhalter, L., Cadzow, R., Watkins, R., Leonard, K. M., & Taylor, J. S. (2007). The
Impacts of Subsidized Health Insurance on Employee's Use of Preventive Health Services. Evaluation & the Health
Professions , 30 (1), 23-34.
Kaiser Commission on Medicaid and the Uninsured. (2006, October). The Uninsured: A Primer. Retrieved
February 17, 2007, from The Henry J. Kaiser Family Foundation: http://www.kff.org/uninsured/upload/7451021.pdf
Katz, A., Grossman, J. M., Hurley, R. E., May, J. H., Nichols, L. M., & Strunk, B. C. (2005). Community
Report. Washington, DC: Center for Studying Health System Change.
Levine, S. R. (2007). The Interplay of Age, Access to Health Care, and Insurance Status. Archives of
Neurology , 64, 15-16.
Minnesota, U. o. (2005, November 11). State Health Access Profile. Retrieved February 17, 2007, from
http://www.sph.umn.edu/shadac/pubs/profile.html
Seifert, R. W., & Rukavina, M. (2006, February 28). Bankruptcy Is the Tip of a Medical-Debt Iceberg.
Health Affairs , 89-92.
-4848
Shi, L., & Stevens, G. D. (2005). Vulnerability and Unmet Health Care Needs. Journal of General Internal
Medicine , 20, 148-154.
The Associated Press. (2006, September 26). Health insurance jumps twice inflation rate. Retrieved
September 26, 2006, from MSNBC: http://www.msnbc.msn.com/id/15014332
The Institute of Medicine. (2006). The Future of Emergency Care in the United States Health System.
Washington, DC: National Academic Press.
Weinick, R. M., Byron, S. C., & Bierman, A. S. (2005). Who Can't Pay for Health Care? Journal of
General Internal Medicine , 20, 504-509.
Other Sources For Citations Found Within This Document
(Special thanks also goes to the Kaiser Commission and the Arkansas Center for Health Improvement
for their research and findings, upon with the Clinic has also extensively relied )
45. Kaiser Commission On Medicaid and The Uninsured, The Uninsured: A Primer—Key Facts About Americans
Without Health Insurance, November 2004, at 6.
46. Kaiser Commission On Medicaid and The Uninsured, The Uninsured and Their Access to Health Care,
November 2004, at 2.
47. Kaiser Commission On Medicaid and The Uninsured, The Uninsured: A Primer—Key Facts About Americans
Without Health Insurance, November 2004, at 6.
48. Kaiser Commission On Medicaid and The Uninsured, The Uninsured and Their Access to Health Care,
November 2004, at 2.
49. Kaiser Commission On Medicaid and The Uninsured, The Uninsured: A Primer—Key Facts About Americans
Without Health Insurance, November 2004, at 6.
50. Kaiser Commission On Medicaid and The Uninsured, The Uninsured: A Primer—Key Facts About Americans
Without Health Insurance, November 2004, at 7.
51. Kaiser Commission On Medicaid and The Uninsured, The Uninsured: A Primer—Key Facts About Americans
Without Health Insurance, November 2004, at 6.
52. Kaiser Commission On Medicaid and The Uninsured, The Uninsured: A Primer—Key Facts About Americans
Without Health Insurance, November 2004, at 7.
53. Kaiser Commission On Medicaid and The Uninsured, The Uninsured: A Primer—Key Facts About Americans
Without Health Insurance, November 2004, at 7.
54. Kaiser Commission On Medicaid and The Uninsured, The Uninsured and Their Access to Health Care,
November 2004, at 2.
55. Kaiser Commission On Medicaid and The Uninsured, The Uninsured: A Primer—Key Facts About Americans
-4949
Without Health Insurance, November 2004, at 1.
56. Kaiser Commission On Medicaid and The Uninsured, The Uninsured and Their Access to Health Care,
November 2004, at 2.
57. Kaiser Commission On Medicaid and The Uninsured, The Uninsured and Their Access to Health Care,
November 2004, at 2.
58. Kaiser Commission On Medicaid and The Uninsured, The Uninsured and Their Access to Health Care,
November 2004, at 1.
59. Kaiser Commission On Medicaid and The Uninsured, Covering The Uninsured: Growing Need, Strained
Resources (2004), at 1.
60. Kaiser Commission On Medicaid and The Uninsured, The Uninsured and Their Access to Health Care,
November 2004, at 1.
61. Kaiser Commission On Medicaid and The Uninsured, Myths About The Uninsured, (Undated), at 3.
62. Arkansas Center for Health Improvement, 2005 Arkansas Fact Book: A Profile of The Uninsured, at 5.
63. Arkansas Center for Health Improvement, 2005 Arkansas Fact Book: A Profile of The Uninsured, at 6.
64. Arkansas Center for Health Improvement, 2005 Arkansas Fact Book: A Profile of The Uninsured, at 6.
65. Arkansas Center for Health Improvement, 2005 Arkansas Fact Book: A Profile of The Uninsured, at 6.
66. Arkansas Center for Health Improvement, 2005 Arkansas Fact Book: A Profile of The Uninsured, at 10.
67. Kaiser Commission On Medicaid and The Uninsured, The Uninsured: A Primer—Key Facts About Americans
Without Health Insurance, November 2004, at 4.
68. Arkansas Center for Health Improvement, 2005 Arkansas Fact Book: A Profile of The Uninsured, at 8.
69. Arkansas Center for Health Improvement, 2005 Arkansas Fact Book: A Profile of The Uninsured, at 11.
70. Arkansas Center for Health Improvement, 2005 Arkansas Fact Book: A Profile of The Uninsured, at 12.
71. Arkansas Center for Health Improvement, 2005 Arkansas Fact Book: A Profile of The Uninsured, at 14.
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