Prevalence of Chronic Disease and Cost Effectiveness of a Free Clinic

Free clinics are a widespread, yet limited research has examined the health status of people served and the cost effectiveness of free clinics. The purpose of this study was to describe the sociodemographic characteristics and prevalence of chronic conditions in patients seen at a free clinic and estimate the clinic's cost-effectiveness. The study was a retrospective chart review of 350 randomly selected paper medical charts (2009-2020) and 1,676 electronic medical records (2020-2022) at the Noor free clinic in California supported by private donors, non-profits, and foundations. Cost-effectiveness was calculated from annual clinic operating costs, services provided, quality-adjusted life years (QALYs) saved, and projected savings from preventing emergency department visits. Of the 350 paper charts reviewed, 336 met inclusion criteria. Patients had an average age of 46.6 years, with most identifying as female (60%), Hispanic (69%), Spanish-speaking (62%), and employed (59%). About 64% had incomes below the federal poverty line. Chronic conditions included overweight/obesity (75%), chronic pain (46%), hypertension (28%), hyperlipidemia (24%), type 2 diabetes (24%), and mood disorders (23%). A quarter of patients had at least one chronic condition, and over half had multiple conditions. The clinic's services in 2022 resulted in an estimated 146 QALYs saved, $11.5 million in cost savings, and a return on investment of $13.18 per $1 invested. The free clinic provided medical care to low-income, Hispanic populations without insurance who historically have been disenfranchised from healthcare access. Cost-effectiveness analysis suggested that it provided significant health benefits and cost savings.