User:Annaou/sandbox

Area
Medi-Cal - focus on denti-cal

Berkeley, California - focus on homelessness

Health care in the United States

Sector
Free Clinic

Berkeley Free Clinic

Area: Medi-Cal
The page is organized and contains information related to Medi-Cal. However, the information there isn't seem to be very in depth. Also, my primary focus on Medi-Cal for my organization would be on Denti-Cal eligibility and logistics, but Denti-Cal seems to just be awkwardly inserted into various sections. It is a bit confusing to constantly alternate back and forth between Medi-Cal and Denti-Cal information, and in my opinion, it would be more helpful to have another section just on Denti-Cal. The article does appear to be very thoroughly cited. The citations are all from the official websites, which is probably the most up-to-date information from the source. However, it may be helpful to include independent sources on the reach and impact of these programs - information that this page seems to be lacking.

Sector: Free Clinic
The article gives a wide overview on free clinics, ranging from the history to its practices to different kinds and examples of free clinics. This information is very interesting to me as it gives more insight into the background of my organization as well as the structure/operation of other similar organizations. It is generally biased towards the pros of free clinics, though. Additionally, it focuses completely on free clinics in the United States, it makes broad claims and generalizations throughout the article. For instance, that hospitals are supportive of free clinics, or that many free clinics are faith-based. It fails to support most of these claims with any citations. There are only three citations on the entire page - one of which doesn't even work. The first citation is to an NPR talk, and the last two are to the websites of free clinics. The page itself has a message on it that says "this article needs additional citations for verification." The talk page only has a conversation on whether free clinics are limited to the United States and on whether this page should be merged with the clinic page.

Health care in the United States
(1) This paper was essentially a survey of the prevalence and costs of alternative medicine options in the 1990s in the United States. It would supply information on the effectiveness and popularity of American alternative medicine use, which is currently not discussed at all in the Wikipedia article.

(2) This paper evaluates how coverage, access, and health has changed following the implementation of the Affordable Care Act and whether there are differences between states that expanded Medicaid versus those that did not. It would help update the Wikipedia article (which has a notice saying it’s out of date) since the last updated information about the ACA was about its implementation in 2010.

(3) This paper summarizes trends in utilization of dental care, finding that increases in certain groups correlated with insurance coverage. It would be helpful in supplying information about dental health care in the United States as the word “dentistry” is currently only mentioned once in the entire Wikipedia article.

Free clinic
(1) This paper describes the experience from the first five years of operation of the Charlottesville Free Clinic to fill the gap in information about demographic and clinical characteristics of patients that go to free clinics. It would provide vital, scholarly background information on who free clinics serve - information that is currently missing from the Wikipedia page.

(2) This paper describes the scope of services provided by 281 of the 355 free clinics that exist nationally and their budgets. It would fill in information on how the clinics operate and what exactly are their capabilities and limitations.

(3) While this paper is clearly biased towards free clinics based on its title, it provides support for its point of view while also including critiques and insights into the future of free clinics. It would act as a more analytical source in contrast to the previous two sources, which provide more straightforward information.

Health care in the United States
// alternative medicine (under Providers)

Outside of the standard health care system, more and more people are seeking alternative treatment options. These treatments are defined as therapies generally not taught in medical school nor available in hospitals. They include herbs, massages, energy healing, homeopathy, and more. A national survey found that from 1990 to 1997, the use of at least one alternative therapy has increased from 33.8% to 42.1%. More recent studies concurred that about 40% of adults in 2007 used some form of Complementary and Alternative Medicine within the past year. Their reasons for seeking these alternative approaches included improving their well-being, engaging in a transformational experience, gaining more control over their own health, or finding a better way to relieve symptoms caused by chronic disease. They aim to treat not just physical illness but fix its underlying nutritional, social, emotional, and spiritual causes. Most users pay for these services out of pocket, as insurance tends to provide either partial or no coverage of most services. Total out of pocket costs in 1997 were estimated to be about $27.0 billion.

// free clinics (under Providers > Facilities)

Besides government and private health care facilities, there are also 355 registered free clinics in the United States that provide limited medical services. They are considered to be part of the social safety net for those who lack health insurance. Their services may range from more acute care (i.e. STDs, injuries, respiratory diseases) to long term care (i.e. dentistry, counseling).

// affordable care act effects (under Healthcare reform debate > Patient Protection and Affordable Care Act (2010))

The first open enrollment period of the Affordable Care Act began in October 2013. Prior to this period, access to healthcare and insurance coverage trends were worsening on a national level. A large, national survey of American adults found that after the act's first two enrollment periods, self-reported coverage, health, and access to care improved significantly. Furthermore, insurance coverage for low-income adults were significantly greater in states that expanded Medicaid in comparison with states that did not expand Medicaid. However, discrepancies do exist between those covered by Medicaid versus those covered by private insurance. Those insured by Medicaid tend to report fair or poor health, as opposed to excellent or very good health.

The financial consequences of the Affordable Care Act are still debated upon. In 2010, the Congressional Budget Office (CBO) estimated that the act would help reduce the national deficit by $143 billion in the first decade, but two months later, the office subsequently acknowledged that there was an additional $115 billion in funds needed that were not originally included in the estimate. Additionally, the CBO estimated that although projected premiums in 2016 would be lower by $100 per person for small and large business health insurance plans with the Affordable Care Act than without, individual plans would be higher by $1,900 with the bill.

// medicaid (under System efficiency and equity > Equity > Coverage)

Being eligible for Medicaid does not guarantee access to healthcare. Physicians may elect to not accept Medicaid patients. According to one study, top reasons for physicians refusing to participate in Medicaid include slow reimbursement, complex regulations, too much paperwork, and the necessity for extra staff to process the excess paperwork.

Free clinic
(new section - Demographics)

Of the 41 million uninsured people in the United States, the 355 officially registered free clinics in the country are only able to provide services to about 650,000 of them. On average, free clinics have annual budgets of $458,028 and have 5,989 annual patient visits. In another survey of three free clinics, 82% of patients reported that they began using a free clinics because they have are uninsured, and 59% were referred by friends/family. In a 1992-1997 survey of the Charlottesville Free Clinic, the patient body consists largely of a low income working class that reflects the demographics of the Charlottesville area. Most of the patients reported that without the free clinic, they would either seek the emergency room or do nothing at all if they got sick. There has been a shift over the years from patients seeking urgent care to patients seeking treatment for chronic illnesses. Combined, these factors suggest that free clinics will require additional resources to order to meet the rising demands of their patient population.

(new section - Effectiveness)

There are several proposed advantages to free clinics. They tend to be located in communities where there is a great need for health care. Free clinics are more flexible in structure than established medical institutions. They are also much less expensive - hence the title "free clinic." Due to their small size, their organization tends to be more egalitarian and less hierarchical, which allows for more direct exchange of information across the clinic. Unlike regular regular practices, they also attempt to do more than just provide healthcare. Some were created as political acts meant to advocate for socialized medicine and society.

However, they do come with their own set of problems. For instance, they are a solution aimed towards serving tens of millions of uninsured Americans, but they function solely on the spirit of altruism. Volunteers must be willing to be available during strange hours of the day and provide professional-level care all without the possibility of financial reimbursement. Additionally, the ability of free clinics to provide long term, sustainable service and maintain continuity of care for patients is questionable, considering the instability of funding and providers. One proposition towards overcoming these challenges involves the creation of a national foundation that officially assists and connects free clinics, allowing them to evolve as necessary.

(under list of free clinics)

The National Association of Free & Charitable Clinics maintains a database of 1,200 free and charitable clinics.
 * Charlottesville Free Clinic, a free clinic located in Charlottesville, VA
 * San Francisco Free Clinic, a free clinic located in San Francisco, CA