For the uninsured and underinsured with few funds, there are a limited number of health care options. To assist in filling this hole in the safety net, hundreds of free or volunteer-based clinics have been established across the country. Although these clinics have existed for years, little data on them exist. In 1999, a mail survey was sent to free clinics in seven Midwestern states. Findings from this survey show that, in a single year, these 106 clinics provided medical, dental, and pharmaceutical services to over 200,000 patients, suggesting that free clinics nationwide are caring for a substantial number of our nation's uninsured. The survey paints a picture of free clinics, the populations they serve, and the services they provide. Given the lack of options for the uninsured and underinsured, free clinics deserve continued recognition, support, and assistance from policy makers, health care providers, and the philanthropic community.

In the current health care environment of competition and market forces, concern has arisen that the classic principle of serving disadvantaged persons may not be fulfilled due to pressures from managed care. Reach Out, a $12 million national program of the Robert Wood Johnson Foundation, was developed to recruit leaders from among practicing physicians to organize projects to care for the uninsured and underserved. Physician volunteerism was a key component of all projects. Thirty-nine Reach Out projects were implemented and carried out across the United States, with average funding per project of $300000 distributed over a period of 4 years. Seven model types emerged, the most common of which, the free clinic and the referral network, accounted for two thirds of the total. At the program's conclusion, 199584 patients were enrolled and 11252 physicians recruited. Project execution was more complex than initially supposed, and major progress commonly was not evident until the third or fourth year, but at least two thirds of the projects are likely to continue with local support. With strong physician leadership and a funded administrative core, organized community efforts can develop and sustain an effective program. Programs such as Reach Out cannot solve the national problem of access to health care, but they can make a small but important impact on the number of uninsured and underserved persons without access to health care.