A free clinic is a health care facility in the United States offering services to economically disadvantaged individuals for free or at a nominal cost. Core staff members may hold full-time paid positions, however, most of the staff a patient will encounter are volunteers drawn from the local medical community. Care is provided free of cost to persons who have limited incomes, no health insurance and do not qualify for Medicaid or Medicare. To offset costs, some clinics charge a nominal fee to those whose income is deemed sufficient to pay a fee. Many free clinics offer services to underinsured individuals; meaning those who have only limited medical coverage (such as catastrophic care coverage, but not regular coverage), or who have insurance, but their policies include high medical deductibles that they are unable to afford. Clinics often use the term “underinsured” to describe the working poor.
Most free clinics provide treatment for routine illness or injuries; and long-term chronic conditions such as high blood pressure, diabetes, asthma and high cholesterol. Many also provide a limited range of medical testing, prescription drug assistance, women’s health care, and dental care. Free clinics do not function as emergency care providers, and most do not handle employment related injuries. Few if any free clinics offer care for chronic pain as that would require them to dispense narcotics. For a free clinic such care is almost always cost-prohibitive. Handling narcotics requires a high level of physical security for the staff and building along with more paperwork and government regulation compared to what other prescription medications require.
The modern notion of a free clinic began in the 1960s in San Francisco when Dr. David Smith founded the Haight Ashbury Free Clinics in 1967  during the summer of love in the Haight Ashbury district. Free clinics quickly spread to other California cities and the rest of the United States. In 1972 a meeting was held in Washington DC where clinic staff from around the country gathered and listened to speakers including Dr. Smith. At this meeting the slogan “Health Care is a Right Not a Privilege” emerged as a theme.
During the 1970s and 80s free clinics continued to evolve and change to meet the needs of their individual communities, however some were unable to survive. Each free clinic was unique in its development and services, based on the particular needs and resources of the local community. There is a saying among free clinic organizations that, if you have been to one free clinic, you have been to all free clinics. The common denominator is that care is made possible through the service of volunteers, the donation of goods and community support. Funding is generally donated on the local level and there is little —if any— government funding. Some free clinics were established to provide medical services in the inner cities while others opened in the suburbs and many student-run free clinics have emerged that serve the under-served as well as provide a medical training site for students in the health professions.
In 2001 the National Association of Free and Charitable Clinics (NAFC) was founded in Washington, D.C. to advocate for the issues and concerns of free and charitable clinics. Free clinics are defined by the NAFC as “safety-net health care organizations that utilize a volunteer/staff model to provide a range of medical, dental, pharmacy, vision and/or behavioral health services to economically disadvantaged individuals. Such clinics are 501(c)3 tax-exempt organizations, or operate as a program component or affiliate of a 501(c)(3) organization.” In time various state and regional organizations where formed including the Free Clinics of the Great Lakes Region, Lone Star Association of Charitable Clinic (Texas), North Carolina Association of Free Clinics, Ohio Association of Free Clinics and the Virginia Association of Free Clinics. In 2005 Empowering Community Healthcare Outreach (ECHO) was established to assist churches and other community organizations start and run free and charitable clinics.
Health care safety net
Some free clinics specialize in providing primary care (acute care), while others focus on long-term chronic health issues, and many do both. Most free clinics start out seeing patients only one or two days per week, and then expand as they find additional volunteers. Because they rely on volunteers, most are only open a few hours per day; primarily in the late afternoon and early evening. Many free clinics are faith-based, meaning they are sponsored by and affiliated with a specific church or religious denomination, or they are interfaith and draw support from several different denominations or religions.
Free clinics rely on donations for financial support. The amount of money they take in through donations to a large degree determines how many patients they are able to see. Because they are unlikely to have the resources to see everyone who might need their help, they usually limit who they are willing to see to just those from their own community and the surrounding areas, and especially in chronic care will only see patients from within a limited set of medical conditions. For example, they will see a patient for diabetes, but are not in a position to help with cancer. Some will see only patents that have no insurance, while others will see the underinsured as well.
Free clinics function as health care safety nets, meaning they provide essential services regardless of the patient's ability to pay. Hospital emergency rooms are required by federal law to treat everyone regardless of their ability to pay, so people who lack the means to pay for care often seek treatment in emergency rooms for minor ailments. Treating people in the ER is expensive and it ties up resources designed for emergencies. When a community has a free clinic, hospitals can steer patients to the clinic who otherwise would have been seen in the ER, patients who have a simple ear ache, pink eye, strep throat, flu, etc. For this reason most hospitals are supportive of free clinics. Hospitals are a primary source for equipment and supplies for free clinics. When they upgrade equipment, they will often donate the older equipment to the local free clinic. In addition some hospitals supply most or all of a local clinics day-to-day medical supplies, and some do lab work free of cost as well.
Free clinics are usually located near the people they are trying to serve. In most cases they are located near other nonprofits that serve the same target community such as food-banks, Head Start, Goodwill Industries, the Salvation Army and public housing. Because free clinics often refer people to other medical facilities for lab work, dentistry, and other services, they are usually found in the same area of town as those medical facilities. Almost all free clinics have working agreements with the other facilities that are willing to assist with the clinics mission. Being close to the other medical facilities makes it easier for patients to get from one to the other. Being close to other medical facilities also makes it easier to find medically trained volunteers.
Most free clinics start out using donated space; others start by renting or leasing space. In time and with enough community support, many go on to acquire their own buildings. Donated space may be an entire building, or it might be a couple of rooms within a church, hospital, or another business. Because the clinic will house confidential medical records, prescription medications, and must remain as clean as possible, donated space is usually set aside for the sole use of the clinic even when the clinic is closed.
Medical malpractice liability
Free clinics can be granted medical malpractice coverage through the Federal Tort Claims Act (FTCA). FTCA coverage includes health care professionals who are acting as volunteers. In addition it covers officers, board members, clinic employees, and individual contractors. Medical malpractice coverage does not occur automatically, each organization must be “deemed” eligible by the US Department of Health and Human Services. To be eligible the clinic must be an IRS recognized nonprofit, that does not accept payments from insurance companies, the government, or other organizations for the services it performs. It also must not charge patients for services. It may receive donations from anyone and any organization; the stipulation is that it may not receive financial reimbursement for service rendered, which by definition a free clinic does not.
The Volunteer Protection Act of 1997 provides immunity from tort claims such as negligence, bodily injury, pain and suffering that might be filed against the volunteers of nonprofit organizations. Thus, volunteers working on behalf of a nonprofit free clinic are covered under the Volunteer Protection Act from most liability claims.
Individual states may offer additional legal protections to free clinics, usually under the states Good Samaritan laws. Free clinics must still carry general liability insurance, to cover non-medical liability, such as slips and falls in the parking lot.
Prescription assistance programs
Some pharmaceutical companies offer assistance programs for the drugs they manufacture. These programs allow those who are unable to pay for their medications to receive prescription drugs for free or at a greatly reduced cost. Many free clinics work to qualify patients on behalf of these programs. In some cases the clinic receive and then distribute the medications themselves, in others they verify that the patient is eligible for the program, and the medication is then shipped to the patient, or patient receives the medication from a local pharmacy.
Some free clinics sole mission is to help those who do not have prescription drug coverage, and cannot afford for their medications, to enroll in prescription assistance programs. Such clinics are known as “clinics without walls” because they dispense with the need to have their own building, exam rooms, or clinical equipment.
Some free clinics are able to assist with dental problems. This is handled either at the clinic itself, if the clinic has its own dental facilities and a dentist; or it is facilitated through a partnership with one or more local dentist who are willing to take referred patients for free. For example, a clinic might have ten local dentists who will each accept two patients per month, so this allows the clinic to treat a total of twenty dental patients each month.
Some clinics use a referral system to handle other forms of specialized medical care.
There is an academic model for free clinics. The Society of Student-Run Free Clinics (SSRFC) hosts a national inter-professional platform for student-run clinics. This allows the sharing of ideas, collaborate on research, information about funding resources and encourages the expansion of existing clinics as well as the cultivate of the new ones. The SSRFC faculty network works to facilitate collaboration between student run free clinics.
List of free clinics
- Berkeley Free Clinic, a free clinic in Berkeley, California
- Gary Burnstein Community Health Clinic, a free clinic in Pontiac, Michigan
- Fan Free Clinic, a free clinic in Richmond, Virginia
- Milan Puskar Health Right, a free clinic in Morgantown, West Virginia
- Suitcase Clinic, a student-run free clinic in Berkeley, California
- UCSD Student-Run Free Clinic Project, a student-run free clinic in San Diego, California
- University of Kentucky Salvation Army Clinic, a student-run free clinic in Lexington, Kentucky
- National Association of Free and Charitable Clinics
- Empowering Community Healthcare Outreach (ECHO)
- MedServices Central Electronic Medical Records for free clinics
- Partnership for Prescription Assistance
- Safety Net Center/AmeriCares U.S. Medical Assistance Program
- Society of Student-Run Free Clinics
- Volunteers in Medicine