Cost Comparison of Treating Uninsured Patients at a Hospital-Based Free Clinic, Emergency Room, and Inpatient Hospitalizations: A Retrospective Chart Review

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The rates of the uncompensated health care services have steadily increased across the nation since 2008. Uninsured individuals are less likely to receive preventative services and are more likely to suffer adverse health outcomes and hospitalization for acute conditions. Providing primary and preventative health care to the uninsured is potentially more cost-effective through free clinics as compared to emergency room (ER) or inpatient care. A retrospective chart review was conducted to compare the cost of treating patients in a free clinic, ER, and inpatient hospitalization at one regional hospital in Pennsylvania.


A descriptive, correlational study was conducted in a rural free clinic and its affiliate hospital in Altoona, Pennsylvania. Patients were selected to participate if they were active patients during the fiscal years of the study. A convenience sample (n = 242) of active clinic patients during the fiscal years of the study was selected for chart review. Consent was obtained to access their records. Medical charts were reviewed for frequency of visits, diagnoses, time, charges of ER, and inpatient hospitalizations for the fiscal years of 2009 and 2010. Direct costs for the free clinic were obtained from the executive director. ER and inpatient hospitalization charges were obtained from the regional hospital chief financial officer.


The data indicate a decrease in average patient clinic visit cost from 2009 to 2010 from $84 to $74. There was a 54% increase in patient visits within that time frame, with patient comorbidities increasing from 1 in 2009 to 4 in 2010. There was found to be a significant positive correlation between clinic visits, inpatient hospitalizations and ER visits in 2009 and a weaker correlation in 2010. Patients were seen in the clinic 23 times their inpatient visits and 45 times their ER visits in 2010.


Implications for practice suggest these clinics can provide primary health care needs to patients without insurance in declining health for a reasonable cost. Overall preventative health care services will decrease ER and inpatient hospitalizations and ultimately health care costs.

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