User:Jsumera/sandbox

Practice Experience Organization
My practice experience is at Mabuhay Health Center. Mabuhay Health Center (MHC) is a free clinic in the South of Market (SoMa) area of San Francisco, CA. It is volunteer-run and UCSF-affiliated. Because SoMa has a large Pilipinx population, MHC receives many elderly Pilipinx patients who do not have health care. MHC focuses on cultural competency, with volunteers able to translate doctors' and medical students' words into Tagalog, as well as teach topics such as mental health and public health related to Pilipinx-American culture. MHC offers physician visits (check-ups), dental services, flu shots, drug/medicine recommendation by pharmacy students, public health services (referrals for housing, insurance, etc.) and mental health services (mental health education and a mental health preceptor on-site).

My role in this organization is a Behavioral Health chair, where I teach the SoMa community and our MHC patients about mental and behavioral health topics. Because there is a stigma against mental health (hiya), Pilipinx immigrants and Pilipinx-American people tend to under-utilize mental health resources.

Mental health of Filipino Americans
Because of my role as a Behavioral Health chair, I must learn about how mental health is perceived in the Pilipinx-American community I work with. Hiya, or shame about weakness, is quite common both in Pilipinx immigrants as well as Pilipinx-Americans.

For this article, I would like to add more in the "Mental Illness" subsection. This section needs more statistics on different types of mental illness. I would also like to add more about the under-utilization of mental health services, and the causes of mental health service under-utilization (hiya). The article also needs more citations, so I would like to edit some sentences in the "Model Minority" sub-section.

Free clinic
My PE organization is a free clinic in San Francisco, providing health services like doctor's visits with physicians, dental care, and flu shots, pharmacy (medicine and prescription) assistance, as well as social support and public health services (referrals for housing, insurance, etc.)

For this article, I would like to add a section titled "Social Services" or "Public Health Services" or something of the sort. Because my PE, as well as many free clinics, offer public health services. My PE org, for example, also has free food, serving as a kind of food bank, and clothes. I would also like to add more and edit the "Operations and Services," especially the sentences about how much money is saved by using free clinics rather than hospital emergency rooms.

Free clinic

 * Is everything in the article relevant to the article topic? Is there anything that distracted you?
 * In the section "Operations and Services," the section about hospital emergency rooms distracted me. I am not sure that this belongs here. Although they did tie it into free clinics by saying "When a community has a free clinic, hospitals can steer patients to the clinic who otherwise would have been seen in the ER, patients who have a simple ear ache, pink eye, strep throat, flu, etc." I think a description of a hospital emergency room's services was unnecessary.
 * Is anything missing that could be added?
 * I believe another section that could be added would be "Public Health Services" or something of that sort. Many free clinics, like my PE organization, or Berkeley Free Clinic, offer additional services that are not acute medicine/dentistry/pharmacy. Free clinics also sometimes partner with other organizations, providing food and acting as a type of food bank. My PE organization also offers mental health services, and I know Berkeley Free Clinic has peer counseling as well. Free clinics can also offer public health referrals, e.g. housing services, legal rights, health insurance.
 * Talk Page
 * The talk page debated on the wording, since the article defines a free clinic as "a health care facility in the United States offering services to economically disadvantaged individuals for free or at a nominal cost." While Wikipedians did acknowledge that a free clinic is not a uniquely American concept, and free clinics exist elsewhere in the world, the concept of a free clinic is more relevant in the US and countries where health insurance is not universal. There was also a suggestion that the article itself be merged with Clinic, but was ultimately left alone.

Mental health of Filipino Americans

 * Is anything missing that could be added?
 * I want to talk about "hiya," a Tagalog (Filipino language) idea of shame that often conflicts with people's reaching out of mental health resources. This whole article needs expansion on different types of mental health issues that affect Filipinos, as well as more information on colonial mentality.
 * I will add a new section on "hiya" as well as expand the section about "mental illness" to include more statistics and data. I would also like to add more information on colonial mentality and immigration in the "causes" section of the article.

Area
Tuliao, Antover P. “Mental Health Help Seeking among Filipinos: a Review of the Literature.” Asia Pacific Journal of Counselling and Psychotherapy, vol. 5, no. 2, 2014, pp. 124–136., doi:10.1080/21507686.2014.913641.


 * This article has a good definition of hiya- "the meaning can range from shy (mahiyain), embarrassment or awkwardness (napahiya), to a sense of propriety (kahihiyan). For the purposes of this paper’s topic, the most apt translation would be embarrassment and a sense of propriety" (Antover 7).
 * Page 7 of Antover's paper has good information on hiya and its relation to mental health service utilization. It talks about how "some Filipinos preferred online counselling because of the anonymity it provided which lessened the effects of hiya."
 * "Among Filipinos, studies show that private stigma is negatively correlated with the intention to seek professional help, and mediates the relationship between public stigma and attitudes towards seeking professional help (Garabiles, Tuliao, & Velasquez, 2011; Tuliao & Velasquez, in press).
 * This literature review describes the barriers that Filipinos (and Filipino Americans) face when utilizing mental health resources, including accessibility, shame, stigma, and collectivist beliefs. A key concept of this article is its definition of hiya (shame about expressing weakness) and Filipinos’ stigma against seeking mental health professional help. I will use this article for its focus on hiya, loss of face, and cultural stigma against mental health. The section about doctors and medical professionals as “ibang tao” (an outsider) is also useful for my work at Mabuhay Health Center. This cultural stigma against mental health and the view of doctors as outsiders who are unable to understand the patient, are going to be important in analyzing the needs of my clinic.

Castro, A. B. De, et al. “Job-Related Stress and Chronic Health Conditions Among Filipino Immigrants.” Journal of Immigrant and Minority Health, vol. 10, no. 6, 2008, pp. 551–558., doi:10.1007/s10903-008-9138-2.


 * In this article, the abstract and introduction talks about immigrant mental health related to job stressors, as well as immigration in general. The article states, "generally, other studies not focused on employment have found that Filipino Americans report racial discrimination and that this discrimination is associated with increased substance use, depressive symptoms, cardiovascular conditions and other health problems."

David, E. J. R. “A Colonial Mentality Model of Depression for Filipino Americans.” Cultural Diversity and Ethnic Minority Psychology, vol. 14, no. 2, Apr. 2008, pp. 118–127., doi:10.1037/1099-9809.14.2.118.


 * This article proposes a new model  that is a more culturally accurate descriptor of Filipino Americans' experiences of depression. I found this article striking because of how it connected colonial mentality to depression and mental health in Filipino Americans. Colonial mentality, which is touched on in the Wikipedia article, can be made more clear with information from this article. This article’s introduction, which has statistics on mental health in Filipino Americans, will also be useful in my Wikipedia article. The article stating “ethnic identity, self-esteem, and acculturation strategies do not exist in a vacuum and are all influenced by larger sociopolitical factors” is also useful for understanding how culture affects mental health.

Mossakowski, Krysia N. “Coping with Perceived Discrimination: Does Ethnic Identity Protect Mental Health?” Journal of Health and Social Behavior, vol. 44, no. 3, 2003, pp. 318–331. JSTOR, www.jstor.org/stable/1519782.


 * stress-buffering effect
 * Ethnic identification involves a sense of ethnic pride, involvement in ethnic practices, and cultural commitment to one's racial/ethnic group (Phinney 19)" --> some will have more sense of pride and more of an ethnic identity than others, even if they are the same ethnicity
 * "for blacks, racial/ethnic identity significantly buffers the stress of both acute and chronic everyday discrimination (not necessarily due to race), such that chronic health problems decline with higher levels of racial/ethnic identification. However, for general self-assessed health, a significant stress-buffering effect is not evident (Williams et al. 1999)"
 * "To specify, "Filipino American" refers to Filipinos who reside in the United States, regardless of place of birth and immigration status."
 * using this article for definition of Filipino American and for the idea of "stress-buffering" in mental health

OBLIGACION, FREDDIE R., and JULIE OBLIGACION-ARBOLEDA. “THE FILIPINO IMMIGRATION STORY: A SELECTIVE LITERATURE REVIEW.” International Review of Modern Sociology, vol. 24, no. 2, 1994, pp. 49–66. JSTOR, www.jstor.org/stable/41420413.


 * has good information on the history of the Philippines and America that I can use -- talks about colonialism (history of the philippines)
 * talks about different waves of Filipino-American migration, which can be useful in the "immigration" section of my article, or can cited as history when talking about colonial mentality and racial discrimination in Filipino-Americans from the 1930s to the 1970s.

Mossakowski, Krysia N. “Are Immigrants Healthier? The Case of Depression among Filipino Americans.” Social Psychology Quarterly, vol. 70, no. 3, 2007, pp. 290–304. JSTOR.


 * This article talks about how Filipino immigrants have better mental health than US born Filipinos. It also talks about how Filipinos have higher rates of depression than other Asian-American groups. "Filipino American immigrants may adhere more to cultural values from the Philippines, identify more strongly with their ethnicity, and have experienced less racial/ethnic discrimination in their lifetimes than US. born Filipinos." This can be useful in talking about cultural differences and hiya, or racial/ethnic discrimination.

Sanchez, Francis, and Albert Gaw. “Mental Health Care of Filipino Americans.” Psychiatric Services, vol. 58, no. 6, June 2007, pp. 810–15. ps.psychiatryonline.org (Atypon), doi:10.1176/ps.2007.58.6.810.


 * "In 1993 the Pilipino Health Task Force concluded that Filipinos in San Francisco lacked health care access because of their low utilization rate. Inadequate Filipino staffing was a barrier to provision of services. Having culturally and linguistically competent providers has been found to be associated with a lower level of need for crisis intervention and higher use of mental health services ( 16 ). Filipino Americans consistently show lower rates of treatment of mental illness. Those who utilize resources were found to be more severely disturbed than white Americans. McBride ( 17 ) found that in nine California Alzheimer's Disease and Diagnostic Centers, Filipinos accounted for only a small number of cases (.7%) of all persons screened in an eight-year period. Separation from family and financial difficulties are common stressors among Filipinos with clinical depression. Among older Filipinos, men commit suicide at a higher rate than women, reflecting the trend among the general population of older Americans. Compared with other Asians, Filipinos were found to have a lower incidence of suicide because of the influence of Catholicism ( 17 ). Suicide rates may also be lower because of the available extended family and social support system. In a study comparing Filipino-American and Caucasian opinions on causation of and treatments for depression and schizophrenia, Filipinos rated spiritual, personal, and social treatments as being more effective than did Caucasians. Filipino Americans considered interpersonal factors (time with family, friendship, and support groups) as important treatments for depression ( 18 ). Filipino Americans cited significant barriers to treatment, including dealing with family hierarchy and reputation, fatalistic attitude and religious fanaticism, lack of belief in one's capacity to change, communication barriers, externalization of complaints, and lack of culturally competent services ( 19 )."

Kim, Hee Jun et al. “Depression among Asian-American Adults in the Community: Systematic Review and Meta-Analysis.” PloS one vol. 10,6 e0127760. 1 Jun. 2015, doi:10.1371/journal.pone.0127760


 * "Estimates varied by Asian racial/ethnic group and other participant characteristics. Estimates of depression among special populations, which included maternity, caregivers, and homosexuals, were significantly higher than estimates obtained from other samples (58.8% vs 29.3%, p = .003). Estimates of depression among Korean and Filipino-Americans were similar (33.3%-34.4%); however, the estimates were twice as high as those for Chinese-Americans (15.7%; p = .012 for Korean, p = .049 for Filipino)."

David, E. J. R., and Kevin L. Nadal. "The Colonial Context of Filipino American Immigrants’ Psychological Experiences." Cultural Diversity and Ethnic Minority Psychology, vol. 19, no. 3, 2013, pp. 298-309''. ProQuest'', https://search-proquest-com.libproxy.berkeley.edu/docview/1411624970?accountid=14496, doi: http://dx.doi.org.libproxy.berkeley.edu/10.1037/a0032903.

Sector
Brennan, M.. Free Clinics: Local Responses to Health Care Needs. Baltimore: Johns Hopkins University Press, 2013. Project MUSE,


 * The sentence in the Free clinic Wikipedia article, "The need for such a clinic arises in societies where there is no universal healthcare, and therefore a social safety net has arisen in its place," could use a reference. This article, page 1-2, states around the same thing. This article states that "the need for the health care safety net is not going away" and that because of the US having millions without insurance, free clinics and the health care safety net was necessary. The sentence "When a community has a free clinic, hospitals can steer patients to the clinic who otherwise would have been seen in the ER, patients who have a simple ear ache, pink eye, strep throat, flu, etc." could also use a reference, from page 2 of the Brennan article. The Brennan article says "Free clinics lessen the strain on other safety net components by preventing unnecessary emergency room visits and hospitalizations. Crump et al. estimated that $6,500 worth of free clinic care saved a local emergency department a net$33,145."
 * This article also has a good section (page 8) on demographics of free clinics, as well as needs of free clinics that serve majority immigrant/PoC clients.
 * The Brennan article, a literature review, asks what barriers free clinics face and how free clinics aim to serve its communities. A key concept from this article is its definition of a health care safety net, and its argument that while free clinics provide necessary short-term care, structural changes must be made to the health care system as a whole. I am using this article for multiple reasons: for its definition of a free clinic as a health care safety net hospital, its statistics on how many people in the U.S. utilize free clinics, free clinic demographics, and barriers free clinics have to serving its population. This article has a section about additional barriers free clinics that serve minority populations (like my PE organization) have, which will be useful. This article also has a section about education programs by free clinics, which will be useful as I write a section of my Wikipedia article about public health and social services free clinics offer.

Beck, Ellen. "The UCSD Student-Run Free Clinic Project: Transdisciplinary Health Professional Education." Journal of Health Care for the Poor and Underserved, vol. 16 no. 2, 2005, pp. 207-219. Project MUSE, doi:10.1353/hpu.2005.0026


 * This article describes the UCSD Student-Run Free Clinic Project, its partners, clinical services, curriculum, funding, replicability, outcomes, elements of success, and transdisciplinary nature.
 * One key point from this article is the interdisciplinary nature of a free clinic, such as the clinic being able to provide mental health services and serve public health needs. The Beck article also describes a student-run clinic structured much like my own PE organization.
 * One section also of interest was about community advocacy, which is useful because my clinic also promotes community building amongst minority populations. The UCSD’s point of “community as a teacher” mimics my own PE organization’s values as well, and its point of cultural competency among minority patients will aid in my work at Mabuhay Health Center.

Darnell, Julie. “What Is the Role of Free Clinics in the Safety Net?” Medical Care, vol. 49, no. 11, 2011, pp. 978–984. JSTOR, www.jstor.org/stable/23053788.


 * The literature suggests that free clinics have emerged in response to limitations in the healthcare safety net, coupled with an intransigent uninsured problem. Accounts of free clinic beginnings, often authored by founders or staff, suggest that free clinics develop because of a convergence of factors: the presence of unmet needs in the community and a willingness to respond to those needs by physicians, nurses, or a group of health professionals" -page 2
 * asks question if free clinics are necessary after healthcare/health insurance reform
 * "health reform is expected to extend coverage to 32 million uninsured individuals,24 thereby (presumably) sapping demand for free clinics. In contrast, an estimated 23 million people will remain uninsured after reform, which suggests that there will be a continuing need for clinics going forward."
 * "providing some of this knowledge by testing 2 hypotheses: (1) free clinic prevalence is higher in communities with higher proportions of uninsured patients, poor adults, and black/African Americans; and (2) free clinic prevalence is lower in communities with greater availability of ambulatory safety net care and more generous state Medicaid programs. These hypotheses draw from leading theories explain ing why nonprofit organizations exist. Hypothesis #1 incorporates the social need theory, which suggests that nonprofits arise in response to people in need of material or financial assistance.25 Hypothesis #2 comes from the "government failure theory," which suggests that the private market will provide an undersupply of public goods and that governments will provide only what is determined by the voting process. This situation tends to leave gaps. In response, nonprofits emerge to fill in gaps left by the market and government.They are gap fillers"

FERTIG, ANGELA R., et al. “BENEFITS AND COSTS OF A FREE COMMUNITY-BASED PRIMARY CARE CLINIC.” Journal of Health and Human Services Administration, vol. 34, no. 4, 2012, pp. 456–470. JSTOR, www.jstor.org/stable/23208391.


 * This article argues that while free clinics and free primary care for the uninsured makes the community's hospital and emergency room more efficient, it is less efficient that previous data show.
 * This article actually approaches the idea of a free clinic in a market framework. Its arguments are about the efficiency of free clincs, and its costs and benefits are market-related (for example, a benefit of free clinics is that investing $1 in a free clinic saves the community $36 in health care costs elsewhere).
 * For this article, I am mostly using the introduction paragraphs and the discussion section, as these sections do not have original research. This article analyzes the costs and benefits of a free primary care clinic, and has statistics on how free clinics save communities ED visits and money. I intend to use this scholarly article on the section of the Wikipedia article about hospital emergency room costs. I think the first 4 pages will be the most helpful, because it has statistics on how ED visits and ED costs per person dropped after free primary care was implemented.

Half-century After “Summer of Love,” Free Clinics Still Play Vital Role Rita Rubin, MA

JAMA. 2017;318(7):598-600. doi:10.1001/jama.2017.8631

John M. Garvin, and Gregory L. Weiss. “Gaining Community Acceptance of a Free Health Clinic.” Public Health Reports (1974-), vol. 95, no. 3, 1980, pp. 259–262. JSTOR, www.jstor.org/stable/4596290.


 * talks about lack of funding in free clinics
 * needs community acceptance (doctors from around the area, willing volunteers, willing patients) for a free clinic to work best

Davenport, Beverly Ann. “Witnessing and the Medical Gaze: How Medical Students Learn to See at a Free Clinic for the Homeless.” Medical Anthropology Quarterly, vol. 14, no. 3, 2000, pp. 310–327. JSTOR, www.jstor.org/stable/649501.


 * Medical students bearing witness to patients
 * "meeting patients where they are," non-judgemental, focusing on quality of attention given
 * Referring to the failing social system that contributes to clinic patients' miseries, he exclaimed, "We're not gonna fix it, but we're gonna bear witness." - page 8
 * "t entails respectful focus on the entirety of a person's life situation, not merely on their ailment. It implies treating each person who walks into the clinic as an individual, not a representative of a class." - page 8
 * an that it was an ideological attempt to alter the balance of power between patients and practitioners in favor of patients"
 * quality not quantity, get full history of patient

Hutchison, Jenny, et al. “The Effect of North Carolina Free Clinics on Hospitalizations for Ambulatory Care Sensitive Conditions among the Uninsured.” BMC HEALTH SERVICES RESEARCH, vol. 18. EBSCOhost, doi:10.1186/s12913-018-3082-1. Accessed 16 May 2019.

Smith, Sunny, et al. “Implementation of a Food Insecurity Screening and Referral Program in Student-Run Free Clinics in San Diego, California.” Preventive Medicine Reports, vol. 5, Mar. 2017, pp. 134–39. Crossref, doi:10.1016/j.pmedr.2016.12.007.

Sector
History of free clinics: started with Haight Ashbury clinic in SF, which was started by Dr. David Smith of UCSF. The idea of the free clinic came during the "Summer of Love," where there was a "growing counterculture of revolution of sex, drugs, and rock-and-roll." When Dr. Smith approached San Francisco city officials, the idea of a free clinic was unpopular because the city wanted to push out the "flower children" instead of caring for their needs. Free clinics arose from unmet needs in the community and health care professionals willing to address those needs.

Role of free clinics: Free clinics are a "gap-filler" in the healthcare system, "satisfying particular types of demands for free care that are currently not being met by governments." "Free clinics do not seem to exist where needs are greatest, suggesting that supply-side conditions--financial and human resources-- play important roles in the existence of free clinics". "Free clinics respond to particular gaps left by publicly supported ambulatory care providers and public financing of healthcare for the poor" (Darnell 5).

Student-run Free Clinics:

At student-run free clinics, medical students are taught to respectfully listen to each patient's life situation, "not merely their ailment" (Davenport 8). Students in their first year of medical school do not have much knowledge of medicine yet, and act as witnesses and healers in the clinic. With their lack of specific medical knowledge and clinical expertise, medical students make the clinic a balance of power between patients and practitioners. Medical students focus more on the patient as a whole instead of a list of symptoms. Medical students listen to the full history of the patient's ailment, including social and environmental factors as well as the" medical aspect of the patient's complaint."

"Because inadequate numbers of licensed practitioners volunteer, free clinics provide medical and graduate students with opportunities to gain service- learning experiences and develop empathy, social awareness, and social and cultural competence. Some clinics use high school and premedical college students to translate or to take on clerical tasks" (Brennan 14).

Stanford, undergraduates assist with administrative

Public Health: Free clinics that serve a homeless population can offer initiatives such as "a soup-kitchen/medical clinic and a mobile clinic" (Brennan 8). Many clinics have implemented health education programs "that are accessible, easily understandable, and multilingual; that emphasize self- management; and that are not dependent on literacy" or community building programs "community partnership approach toward education can include hands- on community- building activities (e.g., cooking classes), a peer- support and mentorship system, or ensuring the availability of healthy food alternatives." (Brennan 11).

Area
Mental Illnesses of Filipino Americans:

From "Are Immigrants Healthier?" article. Filipino-Americans have higher rates of depression compared to other Asian-Americans "and the general population" (white people probably). Estimates of depression among Filipino-Americans is around 33-34%. Filipino-Americans have a higher prevalence of depression than Chinese-Americans.

Immigration:

"This suggests that having a salient ethnic identity is a psychological coping resource, or this cross-sectional effect can be interpreted as depressed individuals being more socially isolated and thus less likely to identify and interact with their ethnic group. Perceived racial/ethnic discrimination is significantly linked (b = .196; p < .001) with increased levels of depressive symptoms: another interpretation is that depressed Filipino Americans are more likely to feel like they have experienced discrimination."

Having a strong ethnic identity can be a good psychological coping resource.

Lead Section
Addition: Filipino-Americans utilize mental health services less than other Asian-American groups.

Suicide
Preceding text: According to the Centers for Disease Control and Prevention, young Filipino women are more likely to have suicide ideation than most minorities.

Addition: However, there are lower rates of committing suicide among Filipinos than Caucasians or other Asian groups. Lower rates of suicide in Filipino-Americans are attributed to the influence of Catholicism in Filipino culture and the availability of social support from extended family.

Depression
Addition: 13.6% of Filipino-Americans are diagnosed with depression. Filipino-Americans have higher rates of depression compared to other Asian-Americans, Caucasians, and the majority of the American population. Filipino-Americans are estimated to have twice the depression rate as Chinese-Americans. U.S. born Filipino-Americans have greater depression rates than Filipino-American immigrants, which may be because of a stronger ethnic identity in immigrants compared to US-born Filipinos.

  

Colonialism
Addition: The after-effects of colonialism (American colonization of the Philippines from 1898 to 1946) still influence some Filipino-American immigrants. One large effect of American colonialism on Filipino-Americans' mental health is colonial mentality.

Immigration
Addition: Filipino-Americans can refer to either immigrants to the United States, or US-born Filipinos. Filipino-Americans, both immigrants and US-born, can face racial discrimination, which is associated with depression and increased substance use. Filipino-American immigrants have lower rates of depression compared to US-born Filipinos. This may be because of a stronger ethnic identity in immigrants compared to US-born Filipinos.

Hiya (new sub-section)
Addition: Hiya, a sense of shame, loss of face, or embarrassment, plays a role in Filipino-Americans' use of mental health services. Hiya plays a negative role in Filipinos' ability to seek help from mental health professionals. The fear of bringing shame to the family can prevent Filipinos from seeking professional mental health aid. Hiya can also cause Filipinos to seek anonymous, online mental health help instead of in-person professional help.

Colonial Mentality
Addition: Colonial mentality impacts self-esteem and weakens ethnic identity, which can negatively impact mental health.

Lead Section
Addition: To offset costs, some clinics charge a nominal fee to those whose income is deemed sufficient to pay a fee.

History
Addition: From there, free clinics spread to other California cities and then across the United States. Free clinics were originally started in the 1960s and 1970s to provide drug treatments.

Patient Demographics
Addition: Free clinic patients are mainly low-income, uninsured, female, immigrants, or minorities. About 75% of free clinic patients are between the ages of 18 and 64 years old.

Student-run clinics
Addition: Free clinics allow student volunteers to become more socially aware and culturally competent in their medical experience. Medical schools sometimes do not address social determinants of health or treatment of underserved populations, and medical students can use free clinic volunteering to learn about these issues. At free clinics, medical student volunteers learn to listen to the full history of their patients and treat them as a whole rather than a list of symptoms. Medical students balance the power dynamic between the patient and provider, acting as a patient advocate.

Operations and Services
Addition: When a community has a free clinic, hospitals can steer patients with simple concerns to the free clinic instead of the emergency room. Free clinics can save hospital emergency rooms thousands of dollars. A $1 investment in a free clinic can save $36 in healthcare costs at another center. For this reason, most hospitals are supportive of free clinics.

Effectiveness
Addition Many free clinics lack funding and do not have enough volunteers. This can contribute to a short availability of free clinics' operation hours, and can harm free clinics' ability to provide long-term, sustainable service.