The feasibility of establishing a free clinic for uninsured patients with neurologic disorders
Summary
The Dream Center Neurology Clinic (DCNC) is a free specialty clinic associated with the Medical University of South Carolina that provides health care for uninsured patients with neurologic disorders. Routine neurologic care is often neglected by free primary care clinics, leaving indigent and uninsured patients to suffer from treatable neurologic ailments. The DCNC was established by supplementing existing resources from a free primary care facility called the Dream Center. Our strategy of building a high-need specialty service into a preexisting primary care infrastructure may provide a blueprint for neurologists who are eager to address the neurologic needs of the underserved in their local communities. According to local charge estimates, the DCNC has provided roughly $120,000 worth of outpatient neurologic care over the past year. The clinic runs through the collaborative effort of medical students as well as academic and private health care providers. Donated services such as EEG, diagnostic lab work, botulinum toxin, supplies, and imaging are also critical to clinic operations. In addition to providing the uninsured with services that are normally inaccessible to them, the DCNC provides a unique educational opportunity for medical students, residents, and all volunteers who are eager to help and learn.
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REFERENCES
1.
Shi L. The convergence of vulnerable characteristics and health insurance in the US. Soc Sci Med 2001;53:519–529.
2.
Bradbury RC, Golec JH, Steen PM. Comparing uninsured and privately insured hospital patients: admission severity, health outcomes and resource use. Health Serv Manage Res 2001;14:203–210.
3.
Hadley J, Steinberg EP, Feder J. Comparison of uninsured and privately insured hospital patients: condition on admission, resource use, and outcome. JAMA 1991;265:374–379.
4.
Gindi RM, Cohen RA, Kirzinger WK. Emergency Room Use Among Adults Aged 18–64: Early Release of Estimates From the National Health Interview Survey, January–June 2011. Hyattsville, MD: National Center for Health Statistics; 2012.
5.
Earnest MP, Norris JM, Eberhardt MS, Sands GH. Report of the AAN Task Force on access to health care: the effect of no personal health insurance on health care for people with neurologic disorders. Task Force on Access to Health Care of the American Academy of Neurology. Neurology 1996;46:1471–1480.
6.
Farhidvash F, Singh P, Abou-Khalil B, Arain A. Patients visiting the emergency room for seizures: insurance status and clinic follow-up. Seizure 2009;18:644–647.
7.
Insinga RP, Ng-Mak DS, Hanson ME. Costs associated with outpatient, emergency room and inpatient care for migraine in the USA. Cephalalgia 2011;31:1570–1575.
8.
Mateen FJ, Geer JP, Frick K, Carone M. Neurologic disorders in Medicaid vs privately insured children and working-age adults. Neurol Clin Pract 2014;4:136–145.
9.
Skolarus LE, Meurer WJ, Burke JF, Prvu Bettger J, Lisabeth LD. Effect of insurance status on postacute care among working age stroke survivors. Neurology 2012;78:1590–1595.
10.
Shen JJ, Washington EL. Disparities in outcomes among patients with stroke associated with insurance status. Stroke 2007;38:1010–1016.
11.
Simpson SA, Long JA. Medical student-run health clinics: important contributors to patient care and medical education. J Gen Intern Med 2007;22:352–356.
12.
Learning objectives for medical student education—guidelines for medical schools: report I of the Medical School Objectives Project. Acad Med 1999;74:13–18.
13.
Smith SD, Marrone L, Gomez A, Johnson ML, Edland SD, Beck E. Clinical outcomes of diabetic patients at a student-run free clinic project. Fam Med 2014;46:198–203.
14.
Smith SD, Yoon R, Johnson ML, Natarajan L, Beck E. The effect of involvement in a student-run free clinic project on attitudes toward the underserved and interest in primary care. J Health Care Poor Underserved 2014;25:877–889.
15.
Swartz MK. The contributions of student-run free clinics. J Pediatr Health Care 2012;26:397.
16.
Rebholz CM, Macomber MW, Althoff MD, et al. Integrated models of education and service involving community-based health care for underserved populations: Tulane student-run free clinics. South Med J 2013;106:217–223.
17.
Gorrindo P, Peltz A, Ladner TR, et al. Medical students as health educators at a student-run free clinic: improving the clinical outcomes of diabetic patients. Acad Med 2014;89:625–631.
18.
Choudhury N, Khanwalkar A, Kraninger J, Vohra A, Jones K, Reddy S. Peer mentorship in student-run free clinics: the impact on preclinical education. Fam Med 2014;46:204–208.
19.
Butala NM, Chang H, Horwitz LI, Bartlett M, Ellis P. Improving quality of preventive care at a student-run free clinic. PLoS One 2013;8:e81441.
20.
Wang T, Bhakta H. A new model for interprofessional collaboration at a student-run free clinic. J Interprof Care 2013;27:339–340.
21.
Shrader S, Thompson A, Gonsalves W. Assessing student attitudes as a result of participating in an interprofessional healthcare elective associated with a student-run free clinic. J Res Interprof Pract Educ 2010;1:23.
22.
Liaison Committee on Medical Education. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree. Washington, DC: Liaison Committee on Medical Education; 2014.
23.
Congressional Budget Office. Effects of the Affordable Care Act on Health Insurance Coverage—May 2013 Baseline. Washington, DC: Congressional Budget Office; 2013.
24.
Congressional Budget Office. Insurance Coverage Provisions of the Affordable Care Act—CBO's February 2014 Baseline. Washington, DC: Congressional Budget Office; 2014.
Information & Authors
Information
Published In
Neurology® Clinical Practice
Volume 5 • Number 4 • August 2015
Pages: 302-308
Copyright
© 2015 American Academy of Neurology.
Publication History
Published in print: August 2015
Published online: August 6, 2015
Disclosures
J.J. Taylor is funded by NIDA F30DA033748. T. Larrew, A. Omole, M. Roberts, A. Kornegay, K. Kornegay, and L. Yamada report no disclosures. G.J. Revuelta has served on scientific advisory boards for Ipsen, Lundbeck, and Chelsea; has received funding for travel and/or speaker honoraria from Teva, UCB, and Lundbeck; has served on speakers' bureaus for Teva, UCB, and Lundbeck; and receives/has received research support from Chelsea, UCB, NIH (NCCAM, National Institute of Neurological Disorders and Stroke), Biotie, Icon, Bachmann-Strauss, Barmore Fund for Parkinson's Research, and South Carolina Translational Center. M. Sohn, T. Hughes, and J.C. Edwards report no disclosures. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.
Study Funding
No targeted funding reported.
Authors
Author Contributions
J.J. Taylor was part of the conceptualization process for this manuscript and made significant contributions to the writing and submission process. T. Larrew played a key role in the conceptualization process for this manuscript. He made significant contributions to the writing process. A. Omole contributed to the manuscript preparation. M. Roberts contributed a student perspective on how this free specialty clinic enriches medical education. A. Kornegay contributed to drafting/revising the manuscript. K. Kornegay assisted with the preparation of this manuscript. L. Yamada made significant contributions to the writing and submission process for this manuscript. G. Revuelta was part of the conceptualization process for this manuscript and made significant contributions to the writing and submission process. M. Sohn has made significant contributions to the writing and submission process for this manuscript. T. Hughes contributed to the writing process. J.C. Edwards was part of the conceptualization process for this manuscript and has made significant contributions to the writing and submission process.
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Cited By
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The article on free neurologic services for uninsured people by Taylor et al.1 was encouraging and in alignment with services we have provided in India for more than a decade. Providing free medical services, especially to those who have limited economic resources, is a novel act of humanity in these modern times. Free medical services have always been available in India for needy or poor patients but are much better organized now. A large percentage of the population was suffering from poverty because of health-related expenses.2 Initially there was provision of free medical services to those below the poverty line including neuroimaging and costly medicines like IVIg, but now free medicine is supplied to every patient in government-run hospitals. Patients with neurologic disorders are referred to more specialized centers for diagnostic tests and treatment. Once enrolled, such patients keep on receiving regular treatment and follow-up at the medical college hospitals. Almost every medical college has a neurology center. Free services are also now available in certain private hospital for patients below the poverty line. While lifting the burden of medical bills from the backs of patients is moving in a positive direction,3 much additional work is needed.4
Disclosures: The author reports no disclosures.
References:
1. Taylor JJ, Larrew T, Omole A et al. The feasibility of establishing a free clinic for uninsured patients with neurologic disorders. Neurol Clin Pract 2015;5:302-308.
2. Medical bills pushing Indians below poverty line: WHO. India Today Online 2011. http://indiatoday.intoday.in/story/medical-bills-pushing-indians-below-poverty-line-who/1/158347.html (Accessed August 29)
3. Sood N, Bendavid E, Mukherji A, Wagner Z, Nagpal S, Mullen P. Government health insurance for people below poverty line in India: quasi-experimental evaluation of insurance and health outcomes. BMJ 2014; 349:g5114.
4. Shukla R. Healthcare spend pushing households below poverty line: Policy-makers need to look at healthcare as a key element of the economic well-being of the country. Financial Times 2015. http://www.financialexpress.com/article/fe-columnist/healthcare-spend-pushing-households-below-poverty-line/126656/ (Accessed August 29)