Tiffany Miller was supposed to drive her 15-year-old daughter to a birthday party. But before the mother of five even made it out the door, she suddenly collapsed and lost all muscle control.

Panicked, Miller’s daughter tried to give her mother her medicine, but Miller was unable to swallow the pills and began to choke. At that point, Miller’s teenage son called 911.

Though she had stopped choking before the ambulance arrived, Miller still couldn’t move and needed medical attention. But even in such dire circumstances, her children knew she wouldn’t be relieved to see the paramedics.

“Mama’s going to kill you now,” Miller’s daughter said to her brother, scolding him for making the call.

Miller is all too familiar with the emergency room, and she already owes Northeast Georgia Medical Center in Gainesville  more money than she can spare. She’s been to the ER “countless times” for sudden fainting spells due to an unidentified central nervous system condition that has plagued her for the last four years.

Her worsening symptoms, which mimic MS, fibromyalgia and chronic fatigue, make day-to-day tasks like driving and grocery shopping increasingly difficult.

Visiting the ER has become “pointless,” Miller said. “I just lay there, sometimes in a hallway, until I’ve regained full mobility and can leave.”

But to stay out of the ER, Miller would need to see a primary care doctor monthly and take five different medications daily.

Uninsured and unable to work for the past two years, Miller couldn’t afford any of those preventive measures until she turned to Gainesville’s Good News Clinics.

It’s Georgia’s largest free clinic, funded by United Way and private charitable donations, and it’s keeping uninsured Hall County residents such as Miller out of emergency rooms.

It also has a benefit that may be less obvious: It significantly lowers health care costs for the county.

Besides allowing Miller to see a primary care doctor monthly, the clinic provides her with two of her five medications free of charge.

At first, Miller admits, she was ashamed to use a free clinic, but now she says she would be lost without it.

“Every month, the worry of how I’m going to pay my doctor is gone,” Miller said. “I have another primary care physician, but it’s $50 to see her. That’s $50 that could go towards our light bill or groceries.”

Cheryl Christian, executive director of Good News Clinics, said many patients have been served there during the economic downturn.

“We’re seeing people who have lost their jobs and their health insurance, and for the first time in their lives are having to reach out to a free clinic,” said Christian.

The economic factor

She said free clinics like Good News are especially important right now. With the high number of uninsured people these days, the free care that these clinics are able to offer reduces unnecessary hospital visits and overall health care costs for Hall County.

A recent University of Georgia study showed that health care for patients at the Good News Clinics costs considerably less than care for uninsured residents who use the local hospital.

Researchers followed 207 new patients at the Good News Clinics for a year and found that annual non-urgent ER and inpatient costs fell from $223,095 to $187,948 a year, saving the county $35,147 in health care costs. This equates to a savings of roughly $170 per patient after enrollment.

“The ER is the most expensive place to get care, and when more uninsured people resort to the ER, it raises health care costs for everyone,” said Angela Fertig, a health economist and researcher on the study.

“Then it’s this vicious cycle — employers [stop] covering their employees, people become uninsured and use resources inefficiently, raising the costs for everyone, and then employers drop even more employees,” Fertig said.

Though non-urgent ER costs fell significantly, providing primary care for a patient who hasn’t seen a doctor in a long while can be very costly at first.

The cost of delivering primary care at Good News in the first year was almost three times greater than the savings — a staggering $505 per patient — but these costs are expected to fall.

“Whenever you have an uninsured person who finally gets access to primary care, you’re going to have high initial costs,” said Fertig. “They are going to have a lot of undiagnosed problems, and are going to need costly diagnostic tests.”

Over time, she said, those initial costs should be recouped, because offering preventive care for the uninsured will eliminate frequent trips to the ER.

Fertig and fellow researchers estimate that three years after a patient enrolls at Good News, the economic benefits of receiving free care will far outweigh the preliminary costs.

“The power of the Good News Clinics partnership is evident in our community,” said Christy Moore, community health improvement manager at the Northeast Georgia Medical Center in Gainesville. “Keeping people well and in the workforce definitely makes a sizeable impact on our local economy.”

Health departments have their limits

Unfortunately for uninsured people in neighboring counties, Good News Clinics offers care only to residents of Hall.

While most Georgia counties have health departments that provide care for the needy, state-funded services pale in comparison to those offered by free clinics, said Dr. David Westfall, director of the Gainesville-based North Public Health District and a co-founder of Good News Clinics.

In addition to primary care, Good News offers dental, pharmaceutical and optometry services.

Health departments focus almost totally on routine preventive services such as cancer and vision screenings and blood tests. “It’s great for preventive services, but the health department can’t really offer anything beyond that,” said Westfall.

He also pointed out that the health department, though equipped with knowledgeable nurse practitioners, has only one licensed physician to oversee daily protocol. This makes prescribing medicine and managing chronic diseases much more difficult.

Westfall knows this dilemma all too well, since he’s his district’s health director and the only physician in charge of its 13 counties.

Now, with an increase in uninsured patrons, Westfall said having one free clinic in the area may not be enough.

“When we started the Good News Clinics, it was our goal to be able to provide care for everyone in need,” he recalled. But due to the recent influx, he said, the clinic now has to focus on “the neediest of the needy.”

Unfortunately for Tiffany Miller, that rather grim description now applies to her. But at least she has somewhere to turn.

“There would be nowhere else to go if this wasn’t here,” she said. “It’s just as personable as any other primary care clinic and it’s invaluable.”

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This article is the latest in a series developed by the Public Health News Bureau, a project funded by Healthcare Georgia Foundation. The bureau is staffed by graduate students from the Health and Medical Journalism Graduate Program at the University of Georgia’s Grady College of Journalism and Mass Communication.

Robyn Abree is a second-year master’s student studying health and medical journalism at the University of Georgia. She’s mainly interested in covering nutrition, fitness, and other forms of prevention and recently worked at GivingPoint, an Atlanta-based nonprofit that educates youth about health and public service.