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...