We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

A Free Clinic Paradox—Reply

Julie Susan Darnell, PhD, MHSA
Arch Intern Med. 2011;171(8):782-790. doi:10.1001/archinternmed.2011.144.
Text Size: A A A
Published online


In reply

McConnel has astutely homed in on a topic of active debate among free clinic practitioners. Unfortunately, McConnel's own cost-per-patient calculations disguise the issue's complexity. Consequently, his conclusion that free clinics are 6 times more costly than CHCs is unsound.

Free clinics and CHCs differ in what costs are counted. Community health centers use Table 8A in the Uniform Data System1 to report staffing, medical care, other clinical services, enabling services, and overhead costs. Unlike the example free clinic—Harrisonburg-Rockingham Free Clinic—CHCs are not allowed to report costs that they do not incur and pay. Community health centers do not report costs associated with specialty care referrals or diagnostic services beyond routine laboratory and radiographic examinations because these generally fall outside their “scope of project.”2 Recognizing the difficulties of uninsured patients receiving these services elsewhere,3,4 the Harrisonburg-Rockingham Free Clinic, like many free clinics, makes formal arrangements with other health care providers for its patients to receive free or reduced cost specialty care and diagnostic services and has reported these downstream costs as part of its enterprise. Excluding the costs for nonroutine diagnostic services and specialty care referrals would substantially reduce the Harrisonburg-Rockingham Free Clinic's costs.

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

14 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
PubMed Articles