Free health clinics have long been caring for people who have no health coverage and limited resources to pay for private care. That’s why services are free. Well, mostly.
A down economy and growing demand has many clinics, including a Kansas City mainstay, reassessing.
Located in midtown Kansas City, the Kansas City Free Health Clinic is big part of the region’s health care safety net, with several dozen full-time staff and several hundred volunteers offering general medicine, dental, mental health, HIV and education services, mainly to people who don't have health insurance (I worked there a few years ago, before becoming a reporter). It's one of the few places in the region where a person isn't charged anything to be seen.
Once 8 a.m. hits each morning, the flood of calls starts coming in from people trying to get a next-day appointment.
“Today I think it took me about 30 to 45 minutes [to fill up] about 100 appointments,” said Angela Stallings, who works the front desk on a recent morning. “It’s a lot. And they still come and come and come.”
Since the recession hit, a record number of people have been turning to the clinic for care -- about 16,000 last year. The volume of services the clinic provided spiked 40 percent, according to the clinic's development director, Kirk Isenhour. Meanwhile, funding from private donations and fundraisers, which helps pay for things like keeping the lights on, dropped 30 percent. For the first time in a decade, the clinic was in the red about $200,000. To offset this, it scaled back its medication dispensary program and now refers most patients to outside pharmacies for $4 prescriptions.
The clinic has also made a more visible change.
Last fall, it started asking patients to pay a $10 donation for their visit. There are now signs posted at the front desk and on the door of the waiting room. The clinic even put in credit card machines.
Isenhour, the clinic’s development director, has been leading the effort. He says in some ways, nothing has really changed.
“When the Kansas City Free health clinic started in ‘71, the clinic was totally funded by what it received from patients, and there was a large jar in waiting room,” Isenhour said.
When the jar dried up, someone would organize a benefit concert or fundraiser and bring the jar with them.
The clinic still has a jar. Well, it’s actually a glass box now. Donation signs and envelopes have always been scattered throughout the place. But Isenhour says it wouldn’t hurt to be more proactive. The money coming in from donations varies a lot from month-to-month, and is usually just a few hundred dollars. It makes up a tiny, tiny part of the clinic’s budget, which also relies heavily on grants.
“If we got a $10 donation from even a third of patients, donations could account for one of our largest funding streams,” said Isenhour. “That could make a difference, and open the door to other revenue, to allow us to continue to serve more patients.”
So how do patients feel about the change?
53-year-old Patricia Pikey is the first person to check in for an appointment on a recent morning. She has come to the clinic for her high blood pressure and chronic back pain ever since she was laid off from a JC Penny Outlet store a couple years ago.
“I don’t mind being asked,” said Pikey. “You know, if anyone has the money they should be able to give it.”
Pikey says she doesn’t have any money today but sends something in when she can.
“I totally appreciate it [the clinic], totally,” said Pikey. “I wouldn’t be able to get medical help without it."
Most people surveyed in the waiting room that morning were okay with the change. But not everyone.
“People come here because they don’t have money so, asking for it upfront is a little bit off-putting,” said Amy Hugunin, who’s at the clinic to have her diabetes checked. She has gotten care at the clinic since she lost her job and health coverage six years ago.
“If it wasn’t for this place, I’d probably be dead by now,” said Hugunin. “But it’s embarrassing to be asked.”
The clinic isn't alone in requesting a fee from patients.
“Across the country, we’re seeing more clinics are having to do this because the donations coming in during this economy just aren’t there,” said Nicole Lamoureux-Busby, director of the National Association of Free and Charitable Health Clinics, which represents about 1200 clinics nationwide.
Lamoureux-Busby says some places have had to make more dire cuts to services.
She doesn’t have the figures, but her perception is that before the recession, about half of free clinics - if not fewer - didn’t overtly ask patients for donations. Now, she says about five out of six do.
Yet, around Kansas City, asking for donations has really been the norm to begin with. Only a handful of clinics don’t directly ask for anything.
"Our patients have always been asked to pay something for care. It’s been $15 since I believe 2001,” said Amy Falk, director of Duchesne clinic, a non-profit clinic for people without insurance in Kansas City, Kansas. "Prior to that, it may have been $10.”
And unlike free clinics, which usually don’t take public or private insurance and rely a lot on volunteers, federally qualified health centers like Swope Health Services charge a sliding fee for people who are uninsured.
Falk says for her clinic, donations don’t make up a huge part of the budget, but they’ve always had an important purpose.
"It encourages patients to take responsibility in their care,” said Falk. “It doesn’t deter [people], as we never turn anyone away because they can’t pay.”
Back in the waiting room of the Kansas City Free Health Clinic, James Hughes waits for his appointment. He’s here for the first time and says the $10 donation doesn’t faze him.
“Compared to the price of insurance, it’s a generous donation to be seen by a doctor,” said Hughes.
Hughes says he's out of blood pressure medication and is glad he was able to get an appointment today. When he ran out last year, he wound up in the emergency room. The bill was several hundred dollars.
“I’m still paying,” said Hughes.
The clinic says whether or not Hughes and other patients are able to pay $10 has no effect on their access to care. There’s no bill, either.
But throughout the country, the days of going to a clinic without being asked for a donation is increasingly becoming something of the past.
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This story is part of a reporting partnership that includes KCUR, NPR
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