HIGH-QUALITY, AFFORDABLE, AND ACCESSIBLE CARE, NOT SECOND-CLASS CARE

Implementation of a safety-net clinic strategy will help communities make major strides in addressing health disparities. However, to be a viable option for the care of uninsured patients, community safety-net clinics must provide high-quality, affordable, and accessible care. Quality First and foremost, the safety-net strategy must provide high-quality care. Volunteer physicians and associate practitioners need to feel that their time and skills are being used to provide high-quality and meaningful care. I have learned in my years as a clinician and as an administrative leader that high-quality care does not have to be expensive care. More magnetic resonance imaging and more brand medications do not necessarily equate to better care. An excellent framework for establishing and tracking quality metrics is found at the HealthConnection Clinic, a Canadian primary care center that serves vulnerable patients.23 This center demonstrates what is possible when a highly engaged leadership shares a common vision and purpose, along with the importance of sustained and meaningful community engagement—an important aspiration for all safety-net clinics. Affordability There are various financial structures for safety-net clinics ranging from free clinics to clinics with sliding fee scales based on ability to pay. However, what they all have in common is they limit their overhead by having a predominately volunteer staff and solid financial support from partners in their communities. They all also have in common that, regardless of their financial model, no patient is turned away for lack of money. Accessibility In many communities, transportation is a major challenge for an uninsured person with limited financial resources, especially if there is no public transportation in the area. I have had patients walk several miles to see us in the office. Clinic location, the hours of operation, and tolerance of late patients are important access considerations for safety-net clinics.