Walk-In Health Clinics

Walk-in health clinics are beginning to show up at big box stores like Wal-Mart. Is this progress towards a better system that satisfies a health care need and brings healthy competition into the provision of services? Or is it the response to a growing failure to provide adequate care for some segments of the population that only partially fills the health care void and brings about concerns that competition will undermine the quality of services?:

Attention Shoppers: Low Prices on Shots in the Clinic Off Aisle 7, by Milt Freudenheim, NY Times: Everyday low prices on strep-throat exams. That is the basic idea behind a retail approach to routine medical care now catching on among consumers and entrepreneurs. At Wal-Mart, CVS and other chain stores, walk-in health clinics are springing up as an antidote to the expense and inconvenience of ... doctors' offices or ... high-cost ... emergency rooms.

For a $30 flu shot, a $45 treatment for an ear infection or other routine services from a posted price list, patients can visit nurse practitioners in independently operated clinics set up within the stores — whose own pharmacies can fill prescriptions.

"It was a lot easier to know you can just drive up the block to a clinic, rather than spend time in the pediatrician's waiting room," said Liz Lyons, who recently brought her 9-year-old son to have a sore throat swabbed in a clinic at a CVS drugstore... She made a $10 co-payment, with her husband's insurance picking up the rest of the $59 tab.

About 100 of these clinics ... are now operating around the nation. Hundreds more are in the works, bankrolled by a range of competing entrepreneurs who include Stephen M. Case, the former AOL chairman; Richard L. Scott, who once ran the nation's largest hospital chain; and Michael Howe, a former chief executive of the Arby's restaurants group...

And most insurers so far are welcoming retail clinics as a way to save money. The uninsured, meanwhile, typically find the clinics more affordable than most alternatives — including the for-profit storefront clinics that have long offered a full range of physician-provided medical services to a walk-in clientele.

Uwe E. Reinhardt, a professor of economics and public affairs at Princeton University, said that the store chains, with their reputations on the line, will insist that the clinics maintain high standards and low error rates. "Primary care is a neglected field in the United States, lagging other economically advanced countries," he said. "The clinics can teach the rest of our health system how primary care could be done and brought to the public."...

[T]he retail clinic trend comes in response to an erosion in employer-sponsored insurance benefits that is forcing people to pay more or all of their own health costs. It is also a reaction to the growing perception that conventional medical service for routine and preventive care has become too costly and inefficient.

"Starbucks has 10,000 locations; health care is certainly more important," said Mr. Case, who made his name and fortune on the Internet but is now betting that his chain of RediClinics at Wal-Mart, Walgreens and other retailers can be the next big thing.

Mr. Case says his epiphany came a few years ago when he took his young daughter to an emergency room on a Sunday for an ear infection. "We waited four hours and they just weren't able to see us," he recalled. "This is crazy: a society in which everything is convenient other than what people care most about, which is taking care of their health."

Mr. Case's company, Revolution Health Group, has 11 RediClinics now running... He plans to open 90 others in various retail chains by the end of this year, and 500 within three years.

Other executives bringing their names and money to the field include Hal Rosenbluth, who sold a travel business to American Express and is now behind a clinic chain called Take Care Health Systems. It has clinics in 16 stores, ... with an eye toward expanding to 1,400 in the next few years. Another in the game is Dr. Glen D. Nelson, a Minneapolis surgeon and investor whose company, MinuteClinic, has branches in 73 stores. ...

The licensed nurse practitioners who run most of the clinics typically have advanced training and referral arrangements with local doctors for cases beyond the clinics' scope. ... For Beth Brauning, 54, a self-employed house cleaner who is uninsured, the prices at a clinic in a CVS ... were a big attraction. The nurse practitioner took her blood pressure and wrote two allergy prescriptions she needed. The bill was $49 — "probably half what my doctor would have charged me," Ms. Brauning said. "It was such a good experience for me. You go to an emergency room, it's $300 to walk in the door."

Having someone in the store writing prescriptions could be a boon for pharmacy chains. "Pharmacy is 70 percent of our business," said Jim Maritan, a CVS vice president for strategy and business development. "It is a great experience having a nurse practitioner clinic on site." But some doctors say the clinic-pharmacy relationship could create conflicts of interest. "We want to make sure that the patient is protected," said Dr. Joseph P. Annis, ... chairman of an American Medical Association council that studied the clinics for a report due out later this month...

Comments

[donna]

Is this what WalMart is doing now in lieu of providing health care for its employees?

Interesting.

[Alejandro]

Maybe 10 years from now we will see people complaining how Wal-Mart has eroded the earnings of doctors by offering cheap health care.

Now seriously...

Markets find their way, just like water. Of course there are market failures ... but the bigger the failure the bigger the incentives to find a way to correct them and profit from it.

Coase, Ronald H. (1974). "The Lighthouse in Economics". Journal of Law and Economics '17' (2): 357–376.

[Alejandro]

Coase' paper is just a reference to show how even the market can find a way to overcome its own imperfections.

[Live Wire]

Except for the fact that this issue involves real people who really suffer, one could only chuckle at labeling this on-going commoditization of health care as a sign of market success. Maybe they could explain how giving Wal-Mart a cut of our limited health-care dollars benefits anyone (other than shareholders) in the long run.

If receiving your health care from a multinational big-box retailer is what Americans consider a success, there appears little reason to be hopeful for the future of American health care.

[cm]

Alejandro: Flu shots are not healthcare, and neither are most walk-in standard procedures that are not based on diagnostics and professional evaluation.

Perhaps you think that piercing your earlobe to install earrings at a mall stand is a successful "market solution" to the problem of expensive surgeries, but I don't.

[Alejandro]

Flu shots are not healthcare, and neither are most walk-in standard procedures that are not based on diagnostics and professional evaluation.

It is not health care? What is it then? If it is not health care then why are they offered with medicare?

Wal-Mart may find the cure for AIDS and you would still be think that it is bad just because Wal-Mart charges low prices and drives Mom&Pop's out of bussines.

[Ninjaplease]

Re: Alejandro

"Wal-Mart may find the cure for AIDS and you would still be think that it is bad just because Wal-Mart charges low prices and drives Mom&Pop's out of bussines."

The only thing walmart has found the cure for is unionized workers, worker healthcare, and high worker wages.

There's a funny thing about those against nationalized healthcare, they claim that we'll face very long lines. But doesn't that suggest that currently there's many people who require healthcare who aren't getting it (assuming you think our lines are currently short) ???

[cm]

Alejandro: OK, I rephrase that, flu shots are by far not all there is to healthcare.

And I didn't say anything about Walmart, Mom&Pops, and cures for AIDS. You must have imagined that.

I have nothing against Walmart or any other purveyor offering standard services that differ from selling OTC pain relievers mostly in that they are administered by a pharmacist and not handed out in a box. But making a revolution of the healthcare market out of that is laughable.

[Michael Davis]

Walk-in clinics is an example of badly needed "Disruptive Innovation." The AMA and traditional Medical Doctors are desperately clinging to an outdated Business Model.

Where else are customers treated with such little respect. There's even a name for such consumers - patients. Passive consumers who need to be told what to do and are not smart enough to make their own decisions.

Long waits and quick "consultations" for routine care will be a thing of the past. The fact that the medical establishment is vehemently opposed to simple, convenient clinics only validates that change will happen - sooner than we think.

Regards,

Michael Davis
Editor - Byvation

[Susan Green]

My take on this comes from a totally different prospective. I am an RN running a company. S.P.I.N. has been established because people like me were tired of watching doctor after doctor open up and really care about the patients to begin with until they started seeing the money flowing in. At that point they start booking Patients, not every 10 minutes but 4 patients in ten minutes. I've seen quick visits turn into mistakes and then mistakes covered up, but the most disturbing of all of it is watching a patient walk out with a diagnosis and no money to pay for the medication that is extemely high. S.P.I.N. focuses in on helping those that can't afford to get their medications. These clinic are teaming up with the pharmacies and getting a percentage, but what about the people those pharmacies see walk away. They should focus on all people, not just those that have the money to pay!

[Wadvex]

Frankly..I don't care WHO does it..Walmart, CVS, etc., etc. But it's 20 years late coming. Understand - I have great insurance but if you think that mean good service think again. My family physician (hopefully) has better diagnostic skills, but he has deteriorated to an 8-5, M-F ONLY guy. If you try to call after hours you're told "go to the ER". Additionally, he has become so legally paranoid he will not even return phone calls (unless it's to a nursing home!) - Even my Vet will call back! And...suppose you do go to an ER - costs and inconvenience aside - the majority of our regional ER's are staffed not by doctors but - you guessed it - Nurse Practioners. The availability of any kind of specialists at local ER's is becoming a thing of the past. From where we live we have to drive over 50 miles to the ONE walk-in facility that is open after hours and on weekends. It is the ONLY such facility within an approximate 150 miles radius that INCLUDES the capital of our state.

[Penny]

As a NP with 12 years experience, I can see why the AMA is concerned about the onset of the minute clinics. A large volume of health care in our country is being managed by Nurse Practitioners and Physicians Assistants. And it's not just the easy stuff. Many years ago, an economist predicted that health care will by a business, bought and sold on the stock market. I thought, no way. But we are. Many physicians are quite happy with our work since we have proven that we can provide high quality health care and generate a clear profit. I believe they have difficulty speaking out against NP's and PA's because we have proven our worth. This battle, however, will not be determined by the patients, but by the legislators. The AMA is a powerful force.