The Impact of Free and Charitable Clinics in Virginia

ASSIGNMENT SECTION
YOU WILL BE GRADED ON APA FORMATTING AND FULL
COMPLETION OF EACH ASSIGNMENT
Assignment 1 – Research Project Statement
Purpose – Offer insight into the nature of the research project, what is being investigated, and
the topic’s significance to the field of HCA. This assignment continues the work done during
the Fall 2018 HCA 300 course. It is an abbreviated version of Assignment 7 (Fall 2018)
* Format (use subheadings for each section)
1)
Title/Topic of research project – also include why you chose this topic; and the
purpose behind the research
2)
Research question being asked (and an explanation in detail of the relationship under
investigation; what is being measured and how)
3)
Research methodology – What is it and how will this help answer the Research
Question (explain in detail) – tools of analysis to be utilized – contingency plan
explained
(Backup plan)
4)
Significance of topic to HCA – how it advances our understanding of the field of HCA
5)
Surveys/Interviews (if being used) to be attached.
6)
Preliminary Reference list showing review of literature up to this date – with a
minimum of 35 references (books, articles, etc.)
*Sources – scholarly works only
* Length
3 pages. (not including Reference list and surveys/interview instruments) double spaced
* Due Date – January 18, 2019
Running head: Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
1
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
2
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
Purpose
The purpose of the proposed research study is to analyze the impact of free clinics on
healthcare access in Virginia. It will investigate to find out whether the free clinics are
undertaking their role in serving the uninsured and underserved patients in the State and
whether they are distributed to cover all the uninsured people across Virginia. The study will
mainly focus on the uninsured and underserved populations in the State given that these are
the people who largely use free clinics.
Free healthcare clinics are essentially volunteer-based healthcare organizations
providing health care services at minimal cost or for free of charge to people who are of lowincome (Hutchison et al., 2018). They are an important avenue for addressing the medical
needs of people who have no health insurance coverage. Even though they often lack the
resources for meeting all the medical needs of people they serve, free healthcare clinics
usually deliver care for chronic conditions and diseases by means of dispensing drugs, regular
monitoring, as well as performing laboratory tests (Hutchison et al., 2018). The healthcare
services they offer might be more limited compared to the ones provided by the mainstream
healthcare organizations which accept insurance largely because they depend on
administrative and medical volunteers, and also have limited funding (Nadkarni & Philbrick,
2013). Although free healthcare clinics in America lack services, organizational structure, as
well as crucial resources in comparison to the mainstream healthcare organizations, Gertz,
Frank and Blixen (2011) mentioned that they still play a very significant role in the country’s
healthcare delivery system. At the moment, not much is known regarding the impact of free
clinics on access to healthcare in spite of the fact that such clinics are among the few possible
alternatives for uninsured and underserved Americans who have limited funds.
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
3
Research Question
The study seeks to address the following overarching research question: How do free
and charitable clinics in Virginia impact access to healthcare? Through this research question,
the study will aim to establish whether free and charitable healthcare clinics in the State of
Virginia would increase or decrease the number of patient visits to the free clinic. The
research question will also help to understand the kinds of medical and health conditions that
the free and charitable healthcare clinics in the State will mainly manage in terms of the
severity of the conditions treated by the clinics, number of referrals to such healthcare clinics,
as well as the number of new cases diagnosed. Furthermore, the overarching research
question is important as it will help understand the demographics of people in terms of
characteristics such as education, race, socio-economic class, gender, and age who will lose
the most or benefit the most with those free healthcare clinics.
Research Methodology
Regarding, the research methodology, the proposed study will use a mixed methods
research methodology. This will entail collecting both quantitative and qualitative data. This
type of methodology generally involves collecting and analysing both close-ended and open
ended data (Creamer, 2017). It is appropriate for the proposed study in that by combining the
qualitative and quantitative approaches, the study will be able to gain in depth and breadth of
corroboration and understanding of the subject matter and offset the weaknesses inherent in
each research method when used individually (Pepe & Castelli, 2013). The mixed methods
research design will also be utilized since the mixing of the two methods will allow the
researcher to understand the research problem better than when the qualitative or the
quantitative approach is used alone (Han, 2018). In addition, this research method will
facilitate triangulation whereby the same phenomenon would be examined through various
methods and data sources (Howell, 2013).
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
4
Quantitative data would be collected from records of distribution of uninsured and
low-income populations in Virginia in relation to distribution of the free clinics in the State.
Additionally, raw data would be obtained from health records of the free clinics. The
quantitative data will be obtained through the use of a map that locates all the free clinics in
Virginia and maps to reveal the locations of people who are uninsured and underserved.
Conversely, qualitative data will be collected through interviews with directors and
administrators of the free clinics in Virginia who comprise the target population. The
researcher will conduct one on one interview through Skype, phone calls, or in person.
Since this is a mixed methods research, data analysis will entail using both
quantitative and qualitative techniques for data analysis (Morgan, 2014). Quantitative data
will be analyzed through descriptive statics such as mean, variance, median. Correlation
analysis will then be used to determine the strength of relationship between cost of healthcare
and accessibility. Also, linear regression analysis would be used to determine the relationship
between free health services and quality of services using the best fit straight line. In this
regard, linear regression equation will be used to predict the impact of free and charitable
clinics in Virginia on access to healthcare. The qualitative data is consisting of interview
transcripts would be analyzed by categorizing the data and comparing them with the
quantitative data (Smith & Zajda, 2018; Chu & Ke, 2017).
Primary and secondary sources of data play an integral role in the proposed study.
Primary sources such as interviews will offer a first-hand account of the subject under study
(Short, 2014). They will allow the researcher to understand how the directors of free clinics
in Virginia think their clinics are impacting access to healthcare within the State. The
primary sources will represent original information. They will provide first-hand or direct
evidence of the subject matter (Garbarski, 2016). On the other hand, secondary sources used
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
5
in the proposed study will offer a restatement, interpretation or analysis of the primary
sources (Adams, 2013).
The mixed methods research methodology will help answer the research question.
The quantitative data will enable the researcher to establish whether the clinics are covering
the uninsured populations or not. The data will comprise several demographics of patients
and divide the uninsured people on the basis of characteristics such as ethnicity, gender,
education and age. The analysis of quantitative data will reveal the strength of relationship
between cost of healthcare and accessibility as evidenced by increase or decrease in number
of visits and number of volunteer staffs coming to the new clinics. It will also demonstrate
the relationship between free health care services and quality of services. The interviews will
aim to explore the topic from the perspective of healthcare providers. The providers will
answer a number of questions about some of the issues concerning quality and funding. In
this way, the research methodology will effectively help address the specified research
questions.
The location/site of the research will be four clinics within the State of Virginia.
These are clinics that offer free healthcare services to underserved and uninsured populations.
Virginia was selected as it has significant health disparities and there are also a number of
free clinics in operation (Mcgarvey et al., 2011). Additionally, Virginia was selected for the
study because it is my primary residence. Also, Working in Virginia’s free clinics as a
volunteer and an intern aroused the interest in the mission of these clinics and therefore
establishing whether or not they are making any impact on access to healthcare. Since these
free clinics often attract a large number of low-income people, there is likelihood that they
have a positive impact by increasing access to healthcare especially to low-income groups
In the proposed study, e-research will play a crucial role since advanced Information
and Communication Technologies would be utilized in supporting the research (Anderson &
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
6
Kanuka, 2013). Ethical aspects would be taken into account when conducting the research.
The following five fundamental principles of research would be observed: firstly,
confidentiality and anonymity of the study subjects would be protected (Pulverer &
Armbruster, 2017). Secondly, informed consent would be obtained from the respondents.
Thirdly, deceptive practices would be avoided. Fourthly, the risk of harm would be
minimized. Lastly, the study subjects would be provided with the right to withdraw their
participation (Stanley, Sieber & Nelton, 2014).
Some theories indicate that increasing equity, for instance by increasing the number
of free clinics, will affect access to healthcare (Petrany et al., 2017; Birs et al., 2016). Over
the past several years, free clinics have emerged across the country in response to limitations
in healthcare together with an intransigent uninsured problem (Darnell, 2011; Pieh-Holder,
Callahan & Young, 2012). Theoretically, the utilization of health-care should correlate with
the need for services (Darnell, 2011; Biello et al., 2010). Even so, some crucial healthcare
services are required but not obtained owing to cost implications (Levesque et al., 2013;
Johnston, Peppard & Newton, 2015). At the moment, it is unclear how free and charitable
clinics impact the access to healthcare (Rubin, 2017; Zucker at al., 2013). As such, examining
the impact of free clinics will help to fill this gap in extant literature.
Significance to the Field of Health Care Administration
This proposed study is significant to the field of health care administration given that
following the passage of the Affordable Care Act in the year 2010 by the administration of
President Obama, there has been a considerable increase in the number of uninsured people
across the nation. These people have greatly overwhelmed care delivery with the free and
charitable clinics playing a vital role in bridging the access to healthcare (Gertz, Frank &
Blixen, 2011; Hutchison et al., 2018).Such clinics employ staffs and volunteers to offer
necessary medical services to many individuals who cannot afford care without needing any
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
7
form of payment (Ghazal & Rambur, 2018; National Association of Free and Charitable
Clinics, 2014). The study will therefore reveal how these clinics are impacting the access to
healthcare for the country’s uninsured and underserved populations. In addition, the topic is
significant since the study will provide a guideline for healthcare policy implementations that
may be advanced to manage the challenges of healthcare in Virginia and other States
nationwide.
The topic is also significant to the Field of Health Care Administration since the
health outcomes for people who are underserved and who are uninsured are considerably
poorer in comparison to those of Americans who are privately insured (Geller, Taylor &
Scott, 2011). Populations that are underserved generally receive lower quality medical care as
well as less medical care. Given that a large number of patients, particularly those with
limited funds, are not able to pay for various health care services themselves, Geller, Taylor
and Scott (2011) stated that public health initiatives have to connect people with local
resources which would facilitate access to the health care needed by those people. Free
healthcare clinics which deliver medical care inexpensively or freely to people who are
underinsured or uninsured are a crucial resource for Americans across nationwide who are
underserved (Kaiser Family Foundation, 2013). Even though it is important to pay attention
to the healthcare quality that such clinics offer, they have demonstrated that they are a vital
aspect of the healthcare safety net for people who are disadvantaged (Geller, Taylor & Scott,
2011).
Previous studies have found that people who lack health insurance have a higher
likelihood of reporting problems receiving necessary medical care compared to people who
are insured (Geller, Taylor & Scott, 2011). About 25% of uninsured adults went without
getting the needed medical care in 2012 owing to cost (Kaiser Family Foundation, 2013). The
main reason for poor access amongst uninsured Americans is that over 50% of uninsured
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
8
Americans lacked a regular place to go to whenever they needed medical advice or when they
are ill (Kaiser Family Foundation, 2013). Over time, healthcare has become less affordable
especially for people who are uninsured, underinsured, and underserved thanks to the
growing costs of healthcare. Furthermore, Americans who are not insured have a less
likelihood of receiving timely preventive care compared to those who have insurance
coverage (Kaiser Family Foundation, 2013). Therefore, the importance of free healthcare
clinics cannot be overemphasized, especially for the underinsured, underserved, and
uninsured.
Limitations
The proposed study has quite a few limitations. Firstly, it will only be carried out only
within one State, namely Virginia. Also, a small sample size would be used since only four
directors of clinics in Virginia that offer free healthcare services would take part as study
subjects. The fact that the study would be carried out in just a single State and very few
participants will participate suggests that the findings may not be generalizable to the general
population (Wilson, 2016). The other limitation is that the mixed methods research could be
extremely complex to conduct (Ingham-Broomfield, 2016). Planning and implementing this
sort of research requires much more resources and time than only conducting a quantitative or
qualitative study (Sweeney & Goldblatt, 2016). Furthermore, it might not be clear how to
resolve discrepancies arising in the interpretation of the results (Venkatesh, Brown &
Sullivan, 2016).
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
9
References
Adams, J. (2013). Research Methods for Graduate Business and Social Science Students.
New Delhi: Sage Publications Pvt. Ltd. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=278216&site=eh
ost-live
Anderson, T., & Kanuka, H. (2013). e-Research: Methods, strategies and issues. Boston,
MA: Allyn & Bacon.
Biello, K. B., Rawlings, J., Carroll-Scott, A., Browne, R., & Ickovics, J. R. (2010). Racial
disparities in age at preventable hospitalization among US adults. American journal of
preventive medicine, 38(1), 54-60.
Birs, A., Liu, X., Nash, B., Sullivan, S., Garris, S., Hardy, M., . . . Pasarica, M. (2016).
Medical Care in a Free Clinic: A Comprehensive Evaluation of Patient Experience,
Incentives, and Barriers to Optimal Medical Care with Consideration of a Facility
Fee. Cureus.
Chu, H., & Ke, Q. (2017). Research methods: What’s in the name? Library & Information
Science Research (07408188), 39(4), 284–294.
https://doi.org/10.1016/j.lisr.2017.11.001
Creamer, E. G. (2017). An introduction to fully integrated mixed methods research.
Thousand Oaks, CA:Sage.
Darnell, J. S. (2010). Free clinics in the United States: a nationwide survey. Archives of
internal medicine, 170(11), 946-953.
Garbarski, D. (2016). Research Synthesis. Public Opinion Quarterly, 80(4), 977–997.
https://doi.org/10.1093/poq/nfw033
Geller, S., Taylor, B. M., & Scott, H.D. (2011). Free Clinics Helping to Patch the Safety
Net.” Journal of Health Care for the Poor and Underserved. 15.1 (20): 42-51
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
10
Gertz, A. M., Frank, S., & Blixen, C. E. (2011). A survey of patients and providers at free
clinics across the United States. Journal of Community Health, 36(1), 83-93.
Ghazal, M., & Rambur, B. (2018). Free Clinics and the Need for Nursing Action in Uncertain
Political Times. Policy, Politics, & Nursing Practice, 1527154418777864.
Han, C. (2018). Mixed-methods research in interpreting studies. Interpreting: International
Journal of Research & Practice in Interpreting, 20(2), 155–187.
https://doi.org/10.1075/intp.00008.han
Howell, K. E. (2013). Introduction to the Philosophy of Methodology. London: Sage
Publications.
Hutchison, J., Thompson, M. E., Troyer, J., Elnitsky, C., Coffman, M. J., & Lori Thomas, M.
(2018). The effect of North Carolina free clinics on hospitalizations for ambulatory
care sensitive conditions among the uninsured. BMC health services research, 18(1),
280. doi:10.1186/s12913-018-3082-1
Ingham-Broomfield, R. (2016). A nurses’ guide to mixed methods research. Australian
Journal of Advanced Nursing, 33(4), 46–52.
Johnston, B. J., Peppard, L., & Newton, M. (2015). Staying connected: Sustaining
collaborative care models with limited funding. Journal of Psychosocial Nursing &
Mental Health Services, 53(8), 36-44.
Kaiser Family Foundation. (2013). The uninsured a primer 2013 – 2014: How does lack of
insurance affect access to healthcare. Retrieved from https://www.kff.org/reportsection/the-uninsured-a-primer-2013-4-how-does-lack-of-insurance-affect-access-tohealth-care/
Levesque, J. F., Harris, M. F., & Russell, G. (2013). Patient-centered access to health care:
conceptualising access at the interface of health systems and
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
11
populations. International journal for equity in health, 12, 18. doi:10.1186/14759276-12-18
McCusker, K., & Gunaydin, S. (2015). Research using qualitative, quantitative or mixed
methods and choice based on the research. Perfusion, 30(7), 537–542.
https://doi.org/10.1177/0267659114559116
Mcgarvey, E. L., Leon-verdin, M., Killos, L. F., Guterbock, T., & Cohn, W. F. (2011). Health
disparities between Appalachian and non-Appalachian counties in Virginia USA.
Journal of Community Health, 36(3), 348-56.
Morgan, D. L. (2014). Integrating qualitative & quantitative methods: A pragmatic
approach. Los Angeles, CA: Sage.
Nadkarni, M. M., & Philbrick, J. T. (2013). Free clinics: a national survey. Am J Med
Sci,330(1):25–31. doi: 10.1097/00000441-200507000-00005
National Association of Free and Charitable Clinics. (2014). America’s free and charitable
clinics: Vital support for 30 million uninsured Americans. Retrieved from
http://nafcclinics.org/sites/defaul HYPERLINK
“http://nafcclinics.org/sites/default/files/NAFC%20Infographic%20%26%20Report%20Feb%202%202015%20small.pdf”t HYPERLINK
“http://nafcclinics.org/sites/default/files/NAFC%20Infographic%20%26%20Report%20Feb%202%202015%20small.pdf”/files/NAFC%20Infographic%20%26%20
Re-port%20Feb%202%202015%20small.pdf
Pepe, A. & Castelli, S. (2013). A cautionary tale on research methods in the field of parents
in education. International Journal about Parents in Education, 7(1) 1–6
Pieh-Holder, K. L., Callahan, C., & Young, P. (2012). Qualitative needs assessment:
healthcare experiences of underserved populations in Montgomery County, Virginia,
USA. Rural & Remote Health, 12(3).
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
12
Pulverer, B., & Armbruster, C. (2017). Where does the buck stop? Research ethics and
publishing. Information Services & Use, 37(1), 13–16. https://doi.org/10.3233/ISU160820
Rubin, R. (2017). Half-century After “Summer of Love,” Free Clinics Still Play Vital Role.
Jama, 318(7), 598-600.
Short, J. (2014). Social Entrepreneurship and Research Methods (Vol. 1st ed). Bingley, U.K.:
Emerald Group Publishing Limited. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=777958&site=eh
ost-live
Smith, K., & Zajda, J. (2018). Qualitative and Quantitative Methodologies: A Minimalist
View. Education & Society, 36(1), 73–83. https://doi.org/10.7459/es/36.1.06
Stanley, B., Sieber, J. E., & Nelton, G. B. (2014). Research Ethics : A Psychological
Approach. Lincoln, Neb: University of Nebraska Press. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=49407&site=eho
st-live
Sweeney, M., & Goldblatt, J. (2016). An exploration of mixed research methods in planned
event studies. Journal of Convention & Event Tourism, 17(1), 41–54.
https://doi.org/10.1080/15470148.2015.1084602
Venkatesh, V., Brown, S. A., & Sullivan, Y. W. (2016). Guidelines for Conducting Mixedmethods Research: An Extension and Illustration. Journal of the Association for
Information Systems, 17(7), 435–495.
Wilson, V. (2016). Research Methods: Mixed Methods Research. Evidence Based Library &
Information Practice, 11(1S), 56–59. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=lxh&AN=114122133&site=e
host-live
Impact of Free and Charitable Clinics in Virginia on Access to Healthcare
13
Zucker, J., Lee, J., Khokhar, M., Schroeder, R. & Keller, S. (2013). Measuring and assessing
preventive medicine services in a student-run free clinic. Journal of Health Care Poor
Undeserved, 24 (1) 344-358.

Purchase answer to see full
attachment