North Carolina free clinics: Effective primary care provider for the uninsured

Although the United States has recently made progress in reducing the number of uninsured in the country as a result of the implementation of the Patient Protection and Affordable Care Act, millions will continue to be unable to access insurance, hindering their ability to receive medical care. The remaining uninsured will have access to care through a patchwork of organizations referred to as the health care safety net.;Free clinics are one part of the safety net that provides care to the uninsured. Free clinics are grassroots, non-profit organizations that provide medical care for underserved populations for free or a minimal donation. The following inter-related papers seek to improve our understanding of free clinics by examining how free clinics in North Carolina affect preventable hospitalizations and emergency room usage, as well as trends in demand for their services from 2010 to 2014.;Uninsured individuals residing in counties in North Carolina that were served by a free clinic had a reduced odds of being admitted to the emergency department for an ambulatory care sensitive condition. A similar relationship was found with admissions to the hospital for an ambulatory care sensitive condition. The hospital analysis utilized a pre/post design with county level fixed effects during a time period when new clinics opened, implying a causal relationship. Finally, despite declining uninsured in North Carolina utilization of free clinics in the state have remained unchanged. Together the three articles emphasize the need for ongoing support of free clinics.