Grace-Marie Turner presented her idea for a national network of charitable clinics at the 2013 Philanthropy Roundtable Annual Meeting.
By Grace-Marie Turner and Tyler Hartsfield
October 17, 2013
In virtually every city in the country, physicians and other medical professionals volunteer their time to provide free or very low-cost health care to patients in need. These clinics are an important part of the safety net and are important to our civil society.
However, the ever-encroaching state is threatening to strangle these private, philanthropic initiatives. The fabric of civil society is fraying as more and more of society’s needs that had been met by community and charitable organizations are being taken over by government.
A new network is needed, modeled after the State Policy Network, to strengthen charity clinics around the country — a Good Samaritan network. This SPN-like organization could help clinic leaders learn from one another, teach others how to start clinics, and help increase the clinics’ profile so Americans learn about the good work they do. SPN could provide the start-up know-how.
Caring for patients
There is a tremendous need, both for patients as well as for physicians, for these charity clinics. At a recent physicians meeting in New Jersey, the session with the single best attendance was one explaining how to set up a charity clinic. Doctors got into their profession to practice medicine, and they desperately want to fulfill what for many of them is a mission. Instead of being buried under mountains of health care regulations, they find these clinics refreshing because they can spend their time caring for patients instead of jumping through insurance and regulatory hoops. And there is still a great need for these clinics: Even with the best-case estimates of the Congressional Budget Office, there still will be 30 million people who are uninsured after the health law takes full effect.[i]
Just one example of a model clinic:[ii]
The Zarephath Health Center in Somerset, NJ, serves as a resource for local churches to provide health care, medications, emotional and spiritual support for families who are in difficult circumstances. It provides a venue for professionals and other volunteers to use their gifts in practical ways by caring for patients. Zarephath utilizes volunteer physicians, nurses, counselors, and financial advisors to provide a comprehensive package of services. The clinic has been operating on a shoestring for nine years and recently moved to larger, donated space.
Civil society in action
There are many other models of faith and community clinics, exemplifying the civil society that Alexis de Tocqueville so wisely observed to be part of our American character. Philanthropists can directly engage, providing expertise and organizational assistance, helping to get donations of needed equipment and supplies, and encouraging professionals to participate. Several states are considering “Good Samaritan” legislation to allow physicians licensed in other states to provide charity care in their states (prohibited under current law), offering opportunities to engage in public policy.
There are more than a thousand of these charity clinics already in action, silently providing care to the neediest patients. But there has not been a national effort to network them together to give them a larger presence. These clinics are a resource that already exists and which could become much more robust if they were to have the benefit of a Good Samaritan network to strengthen this very American example of civil society in action.
The State Policy Network (SPN) provides a model for such a network. SPN is a national network of state-oriented think tanks in the United States. To advance its mission, SPN provides leadership development, management training, and networking opportunities for think tank professionals. A Good Samaritan network would do the same with charitable clinics nationwide. In addition to the functional support the network would provide to charitable clinics, it would also increase their national profile. This exposure would attract more volunteers and more donors – the cornerstones of charitable clinics.
Supply and demand will be great
With the new health law going into effect, charitable clinics will be as important as ever. Under best estimates, the law will leave at least 30 million people uninsured. Many people who technically have insurance will need this source of care. Dr. Alieta Eck, founder of the Zarephath Health Clinic in NJ, describes it this way: “Medicaid recipients often have a lot of trouble finding anyone who will treat them because the program pays them so little.” Eck explains that physicians who accept Medicaid are also burdened. “When you’re getting reimbursed $17 for a visit, it won’t be long before you close your doors because you can’t pay your staff.”[iii] Millions of people would otherwise flood hospital emergency rooms or go without care if there is not an alternative resource for them through charity clinics.
Clinics help patients and providers. The new health law is expected to send a multitude of doctors into early retirement. A 2013 Deloitte survey of U.S. physicians found that six in ten physicians think “it is likely that many physicians will retire earlier than planned in the next one to three years.”[iv] The uninsured provide the demand for charitable care while early retiring physicians will be looking for an opportunity to continue to offer their skills to patients in need.
For supply and demand to meet, retired doctors will need to have a place to donate their professional services. A Good Samaritan Network will provide that opportunity by facilitating the creation of new clinics and connecting willing volunteers with existing facilities.
Care, not bureaucracy
According to the same Deloitte survey, 22% of physicians who are dissatisfied with practicing medicine list “dealing with Medicare, Medicaid, or government regulations” as the greatest element of job dissatisfaction. Charitable care is an opportunity for doctors to help people without having to jump through the regulatory hoops of the government and insurance companies.
Mike Norris, a retired physician who is the medical director of the Founders Clinic in Oregon City, says volunteering at charitable clinics “provides a rewarding opportunity to treat patients without the constraints of time and paperwork that often occurs in practicing medicine today.”[v] Eck, of the Zarephath Health Clinic, says volunteering “ennobles me and it ennobles the patient…I come away each time feeling good that I was able to make a difference.”
Many doctors don’t donate their time because they are unaware of the great opportunity. The Good Samaritan Network would tap into this abundant supply of charitable care by providing increased national exposure for charitable clinics.
Clinics need stability
Another invaluable benefit such a network would provide to charitable clinics is stability. Many charitable clinics rely on yearly donations to keep their doors open. Sustaining fundraising on a year to year basis was difficult enough for charitable clinics in the past, and now the health law is adding more roadblocks. Bill McGinley, president of the Association for Healthcare Philanthropy, has said, “Donors are very reluctant now…They want to know what will happen.” He continues, “Donors aren’t sure the local institutions they are used to supporting will even be there next year.”[vi] At a time of uncertainty and turmoil in the healthcare world, the Good Samaritan Network could provide the support to ensure charitable clinics can continue to provide their services for the neediest Americans.
Because many charitable clinics struggle to sustain their donations, they are often forced to accept federal funds to keep their doors open. But with federal funds, come federal regulations.
Debra Blum of The Chronicle of Philanthropy reported that last year, the Free Medical Clinic of Greater Cleveland was forced to start charging patients on a sliding scale to meet the new requirements for receiving federal funds under the Affordable Care Act. Clinic leaders were concerned that the new rates would make their care unaffordable for some patients and discourage others from seeking care altogether.[vii] There shouldn’t be financial barriers that prevent someone from receiving the medical care they need. Unfortunately that is impossible in some cases when a clinic accepts federal funds.
A strong support network would allow charitable clinics to function without the crutch of federal taxpayer assistance. That would mean less wasted time completing tedious paperwork and the elimination of regulations that prevent patients from getting the care they need.
Providing the most cost-effective care
In addition to providing a more care-friendly environment than federally-funded health centers, charitable clinics also provide more cost effective care. Uninsured people who need medical services but do not have access to charitable clinics are often forced to receive routine medical care in an emergency room. The cost of care in an emergency room is at least $1,000 and often much higher. A similar visit to a federal community health center is estimated to cost between $140 and $280. The cost to visit a non-government charitable clinic can be as low as $13.[viii] Uninsured emergency room visits are a significant driver of health costs in the U.S. health system. Federally-funded health clinics help alleviate that cost, but non-government charitable clinics provide care at a tenth of their cost. Greater national recognition for charitable clinics would help to educate the public into just how far their charitable dollars are going – ten times further in a charitable clinic than a federally-funded community health clinic.
We were able to find two small existing networks similar to the proposed Good Samaritan Network. One is ECHO – Empowering Community Healthcare Outreach. Another is Volunteers in Medicine.
ECHO is an organization that helps churches and other community organizations to develop charitable healthcare clinics. To accomplish their mission, they research the ever-changing challenges of providing health care in America, they motivate and recruit churches and other community organizations to develop primary care clinics, and they provide low cost consulting to these organizations to guide them through the development process. ECHO currently has 36 open clinics across 13 states with another 11 clinics in development.[ix]
Volunteers in Medicine describes itself as “the only national nonprofit dedicated to building a network of sustainable free primary health care clinics for the uninsured in local communities.” When VIM helps to open and establish a clinic, that clinic joins the VIM Alliance. As of September, 2013, there were 96 clinics in the VIM Alliance.[x]
The Good Samaritan Network would provide services similar to both of these organizations but on a much grander scale. The network would seek to connect clinics in each of the 50 states. One key difference between the Good Samaritan Network and ECHO and VIM, is that not only would the Good Samaritan Network help to establish new clinics, but it would also seek to connect and support clinics that already exist. Establishing new clinics is important, but so is maintaining and strengthening clinics that already do charitable work.
Charitable giving promotes civil society and strengthens communities. This network empowers doctors and volunteers to help people in need, and it empowers the uninsured and needy to receive the medical care they need in a dignified and caring setting.
ReasonTV’s video about Dr. Eck and the Zarephath Clinic can be found HERE.
Grace-Marie Turner is president and Tyler Hartsfield is a policy analyst for the Galen Institute, a non-profit research organization focusing on market-based health policy ideas. They can be reached at email@example.com and firstname.lastname@example.org.
[i] “CBO’s Estimate of the Net Budgetary Impact of the Affordable Care Act’s Health Insurance Coverage Provisions Has Not Changed Much Over Time,” Congressional Budget Office, May 14, 2013 <http://www.cbo.gov/sites/default/files/cbofiles/attachments /44190_EffectsAffordableCareActHealthInsuranceCoverage_2.pdf>
[ii] Zarephath Health Center <http://www.zhcenter.org/>
[iii] “How Medicaid & Obamacare Hurt the Poor – and How to Fix Them,” Reason TV, April, 25, 2013 <http://www.youtube.com/watch?v=Cmr1HFzFGuI>
[iv] “Deloitte 2013 Survey of U.S. Physicians: Physician perspectives about health care reform and the future of the medical profession, Deloitte Center for Health Solutions, 2013 <http://www.deloitte.com/assets/Dcom-UnitedStates/ Local%20Assets/Documents/us_chs_2013SurveyofUSPhysicians_031813.pdf>
[v] Cathy Siegner, “New Oregon City health clinic offers free care to low-income, uninsured Clackamas County adults,” The Oregonian, February 23, 2012 <http://www.oregonlive.com/oregon-city/index.ssf/2012/02/new_oregon_city_health_clinic.html>
[vi] Debra E. Blum, “Fundraisers Worry About Losing Donors Under New Health-Care Law,” The Chronicle of Philanthropy, September 12, 2013 <http://philanthropy.texterity.com/philanthropy/20130912?pg=7#pg7>
[vii] Debra E. Blum, “Fundraisers Worry About Losing Donors Under New Health-Care Law,” The Chronicle of Philanthropy, September 12, 2013 <http://philanthropy.texterity.com/philanthropy/20130912?pg=7#pg7>
[viii] Alieta Eck, MD, “On Reducing Inappropriate Emergency Room Use by the Poor,” Testimony to the US Senate Committee on Health, Education, Labor and Pensions, May 11, 2011 <http://www.aapsonline.org/index.php/site/article/ aaps_president_elect_testifies_before_senate_subcommittee/>
[ix] Empowering Community Healthcare Outreach <http://echoclinics.org/>
[x] Volunteers in Medicine <http://volunteersinmedicine.org/>
Grace-Marie’s presentation at the Philanthropy Roundtable.