Week 2 Blog: If these retail discount chains are successful-who stands to win and who stands to lose?
As health care costs continue to rise, employers and the government will continue to shift some of that burden onto employees. There will be more incentives for employees to seek out cheap health care. For example in recent years employers offered reduced copayments for generic prescriptions with higher copays for brand name drugs. So it is no surprise that consumers have responded by choosing generics. Insurers have now started to give financial incentive to use retail clinics rather than the more expensive family doctor, urgent care, or emergency rooms.
www.chcf.org Health Care in the Express Lane: The Emergence of Retail Clinics
Whether retail clinics will be a success or not is anyone’s guess at this point. However, one thing is perfectly clear. They are responding to patients need for quick, relatively cheap health care for basic ailments. So if they are a success, patients with common medical illnesses will win: cheaper and quicker than going to a doctor, or emergency room. But it needs to be stressed that patients with only the easiest health care problems – ear & sinus infections, strep throat, minor allergies, will be helped. Those that have chronic, complicated conditions will not benefit; it is beyond the scope of retail-based clinics to diagnose and treat diabetes or leukemia. So if retail clinics can help with the simple illness, perhaps there would be more time for the doctor’s offices and emergency rooms to handle the complicated cases. But some feel that this may be a problem. Alan Garber, director of Stanford University Center for Health Policy, supports the general idea of in-store clinics, but worries about the way these clinics could affect the rest of the health care system. “One of the fears that I am sure many doctors’ offices have is that the doctors will be left with the complicated patients who may not bring in much revenue but take an extraordinary amount of time.” http://abcnews.go.com/nightline/print?id=2577785 Future of Health Care or Quick Fix?
From that same article, the American Academy of Pediatrics announced that it opposes the use of the retail clinics in that it worries about the “continuity of care,” the gathering of information about a patient over many visits and over multiple health care providers. “I’m concerned that some things are going to be missed,” said Dr. Denice Cora-Bramble, a pediatrician and the executive director of Community Pediatric Health at the Children’s National Medical Center in Washington, D.C. “It’s understanding what are some of the other issues in the life of a child that impact that particular encounter.”
Consumers like what they see with these clinics:
- Most said retail health clinics could provide basic medical services when doctors’ offices were closed or couldn’t fit them into their busy schedule.
- Most agreed the clinics offered a fast, easy way to get basic medical services at very reasonable prices. (October 2005 Harris Interactive poll) http://www.aafp.org/online/en/home/publications/news/news-now/archive/retailclinics.printerview Retail Clinics Now Part of Health Care Landscape
The physician response was concern about quality and that their patients could be diverted away from their offices. Take Care Clinic (based in Conshohocken, PA) spokeswoman Lauren Tierney claims that they are not out to be a means of competition to the physician. She states they are looking to refer patients to physicians in communities where they are operating.
But the patient may not go to a private doctor if they feel better and don’t want to wait for an hour or more in a doctor’s office and pay an enormous fee; remember the reason they went to a retail clinic in the first place. Some have suggested that the family practice physician could join forces with the clinic, but doctors must realize to keep the prices in a clinic down, doctors are not going to get paid what they are use to.
So what about family practice physicians competing with retail clinics by offering open-access scheduling or expanding services to include evening and weekend hours? Many do that now, but the charges continue to be high.
In the poll that was mentioned earlier most respondents felt that a serious medical condition could be missed or inaccurately diagnosed in a retail health clinic and there was concern about the qualifications of the clinic’s staff. (Most are nurse practitioners, who earn about half the salary of a physician). Many patients may not want to see someone they don’t know, but I think that is the older population
Group 1
www.chcf.org Health Care in the Express Lane: The Emergence of Retail Clinics
Whether retail clinics will be a success or not is anyone’s guess at this point. However, one thing is perfectly clear. They are responding to patients need for quick, relatively cheap health care for basic ailments. So if they are a success, patients with common medical illnesses will win: cheaper and quicker than going to a doctor, or emergency room. But it needs to be stressed that patients with only the easiest health care problems – ear & sinus infections, strep throat, minor allergies, will be helped. Those that have chronic, complicated conditions will not benefit; it is beyond the scope of retail-based clinics to diagnose and treat diabetes or leukemia. So if retail clinics can help with the simple illness, perhaps there would be more time for the doctor’s offices and emergency rooms to handle the complicated cases. But some feel that this may be a problem. Alan Garber, director of Stanford University Center for Health Policy, supports the general idea of in-store clinics, but worries about the way these clinics could affect the rest of the health care system. “One of the fears that I am sure many doctors’ offices have is that the doctors will be left with the complicated patients who may not bring in much revenue but take an extraordinary amount of time.” http://abcnews.go.com/nightline/print?id=2577785 Future of Health Care or Quick Fix?
From that same article, the American Academy of Pediatrics announced that it opposes the use of the retail clinics in that it worries about the “continuity of care,” the gathering of information about a patient over many visits and over multiple health care providers. “I’m concerned that some things are going to be missed,” said Dr. Denice Cora-Bramble, a pediatrician and the executive director of Community Pediatric Health at the Children’s National Medical Center in Washington, D.C. “It’s understanding what are some of the other issues in the life of a child that impact that particular encounter.”
Consumers like what they see with these clinics:
- Most said retail health clinics could provide basic medical services when doctors’ offices were closed or couldn’t fit them into their busy schedule.
- Most agreed the clinics offered a fast, easy way to get basic medical services at very reasonable prices. (October 2005 Harris Interactive poll) http://www.aafp.org/online/en/home/publications/news/news-now/archive/retailclinics.printerview Retail Clinics Now Part of Health Care Landscape
The physician response was concern about quality and that their patients could be diverted away from their offices. Take Care Clinic (based in Conshohocken, PA) spokeswoman Lauren Tierney claims that they are not out to be a means of competition to the physician. She states they are looking to refer patients to physicians in communities where they are operating.
But the patient may not go to a private doctor if they feel better and don’t want to wait for an hour or more in a doctor’s office and pay an enormous fee; remember the reason they went to a retail clinic in the first place. Some have suggested that the family practice physician could join forces with the clinic, but doctors must realize to keep the prices in a clinic down, doctors are not going to get paid what they are use to.
So what about family practice physicians competing with retail clinics by offering open-access scheduling or expanding services to include evening and weekend hours? Many do that now, but the charges continue to be high.
In the poll that was mentioned earlier most respondents felt that a serious medical condition could be missed or inaccurately diagnosed in a retail health clinic and there was concern about the qualifications of the clinic’s staff. (Most are nurse practitioners, who earn about half the salary of a physician). Many patients may not want to see someone they don’t know, but I think that is the older population
Group 1
Michelle Au
Sara Ca
Janet Co
Kari Fl
Diane Fu
Shakeitha He
posted by Retailing in Healthcare @ 7:57 PM
8 comments
8 Comments:
Group 1, your posting speaks a lot of truths about the up coming push towards retail physician clinics. However while I agree that retail physician clinic stands to save some patients money in the short term I think that the long term effects could be devastating to our healthcare economy for one major reason.
In the U.S. it’s no secret to med students that becoming a general practitioner in most cases will bring less money and more frustrations. This is in Comparison to many specialist positions which are more attractive financially and often bring more recognition.
My fear is that adding another factor such as retail clinics stands to take a huge chunk of business from the general practitioner. Ultimately one could assume that this might be the final blow to the general practice which is already experiencing many shortages. These retail clinics have chosen the most common ailments seen by many physicians on a daily basis. This means that the largest populations of in patient visits have now been taken away from the general family practice when placed in an environment where retail clinics exist.
It’s easily foreseeable that soon many general family practices will be shut down due to the loss of traffic. This means that when one of these retail clinics can’t treat an ailment they will be looking to dump these patients on family practices that don’t exist. In those cases these patients will be referred to more expensive specialists ultimately costing the patient and the system more money.
jonathanpe, thanks for responding to our posting with your thoughtful ideas. Yes, I agree that retail clinics, although good for certain minor ailments, may create huge problems for the general practice office. From the quote of Dr. Garber from the ABC news link in the original posting, he states that the grestest fear is that many very sick patients will be left to visit the private physician, costing the practice much money and time.
But until the healthcare of Americans finds a better remedy, retail health clinics seem to offer help for a certain portion of the population.
Diane Fu
Jonathanpe,
Good analysis, especially of the impact on the general practitioner. Equally good response by the group.
What about uninsured and the underinsured. Consider the working mother that doesn't have all day to spend in an Emergency Department with a child for an ear infection. The retail clinics respond to the needs of these groups. And they do so efficiently and a much lower cost than traditional health care settings. How do you put that genie back in the bottle?
If this is a duplicate posting I'm sorry. I lost power. I've found your site interesting. It seems to me that a high proportion of patients who go to a doctor aren't seeing the doctor anyway -- they are seeing a physician assistant or nurse practitioner. More information on that would be interesting. A March 2006 Business Week article that cited a RAND study stated that most everyone is getting lousy health care anyway, regardless. In my hunting around I found that a Convenient Care Industry is emerging and there's now an association, the Convenient Care Association
http://www.convenientcareassociation.org/. Seems quite credible.
You all make good points regarding the future of our healthcare. I believe that the fact that these clinics exist is an example of why our healthcare system is becoming more consumer driven. Patients are not willing to wait long times to see physicians and then pay a lot of money for it. This is especially true when the ailment is minor. The decline in the number of general practitioners could be the reason for this dissatisfaction and the consumer response is the cause of future decline.
Janet C.
11/3/06
Even though the jury is still out concerning the ramifications of retailing in healthcare, the potential upside is tremendous. A major deficiency in our healthcare system is the lack of access to care for all Americans. In a recent newspaper article titled, “A true values issue: basic, quality health care for every American”, author David Doman provided some startling statistics. More than 46 million Americans are uninsured (census data from 2005) and included in that amount are almost 9 million children. It states “every year, more than 2 million uninsured Americans are financially ruined by the unexpected cost of profound illness or injury” (Doman, p.5a, 2006). In addition, according to the Institute of Medicine, “ more than 18,000 Americans annually die needlessly because of a lack of healthcare access” (Doman, p.5a, 2006).
The most interesting part of the article dealt with the war in Iraq. The U.S. plan is to develop a nationwide network of healthcare clinics in Iraq to enable healthcare access for all their citizens.
It states, “all people should have access to basic healthcare” (Doman, p.5a, 2006). Why is this essential human value an element of our foreign policy and not a central part of our domestic healthcare agenda?
The issue of paying for universal healthcare access was then discussed and a fascinating perspective was brought forth. The Congressional Budget Office has estimated that a central healthcare access plan would cost about 90 billion annually. However, “the annual cost of not insuring all Americans would be more than 150 billion in lost worker productivity and tax revenue” (Doman, p.5a, 2006). The author came up with a solution to this access problem by instituting a two-tiered healthcare system that would mirror our education system.
In our country, “every child, regardless of economic means, has access to public education through high school” (Doman, p.5a, 2006). “Yet, in this country, we treat healthcare access as a luxury and not a fundamental human need, as fundamental as education, perhaps more so” (Doman, p.5a, 2006). His idea is to establish “a two-tiered healthcare system that would preserve the private healthcare system that affords 85 percent of Americans quality health care, provider choice and convenience” (Doman, p.5a, 2006). “For the 15 percent of uninsured Americans, a public healthcare system could come through an expanded national health clinic network or, in the other extreme, the nationalization of the very successful Medicare program” (Doman, p.5a, 2006).
This idea of creating a national health clinic network to serve the uninsured population is more feasible now that retail healthcare clinics have proven to be successful. “Access to medical care is one of the key determinants of health and is a significant benchmark in assessing the effectiveness of the medical care delivery system”(Shi, L. & Singh, D. 2004). If this essential human value of providing universal healthcare access to all is sanctioned in Iraq, it definitely should be implemented in this country. We deserve no less.
References:
Doman, D. (2006, November 2). A true values issue: basic, quality healthcare for every American. The Daytona Beach News-Journal. Vol. LXXXIII. No. 306. p. 5a.
Shi, L. & Singh, D. (2004). Delivering Health Care in America: A Systems Approach. 3rd ed. Sudbury, MA. Jones and Bartlett.
A new Wall Street Journal Online/Harris Interactive Health-Care Poll shows that while few adults have ever used an onsite health clinic in a pharmacy or retail chain, the majority of all adults agree that these retail-based clinics may provide benefits such as more convenience, accessibility, and perhaps services at a lower cost. “Among those who have never gone to an in-store clinic for healthcare services, 59% say they would be not very or not at all likely to use such a clinic and 41% say they would be somewhat or very likely to use one for basic medical services.” While adults see the possible benefits, many have concerns about the quality of care they would receive at these clinics and from whom they would receive it.
While many say they would probably not use the clinics, those who have used the service have been most satisfied with its convenience, quality of care, and cost, and even though many adults say they probably wouldn’t use the service, they can agree that retail clinics may provide faster care with an acceptable degree of quality. The caveats that the survey revealed were such things as retail clinics providing unacceptable levels of care, and the perception that they are just another way for big corporations to make more money.
In any case, the parties set to benefit from the retail clinics, according to the survey, are those who need basic care, through faster care delivery, as well as current hospitals, whose Emergency Departments are inundated with patients who only need basic care.
Many Agree on Potential Benefits of Onsite Clinics in Major Retail Stores That Can Provide Basic Medical Services, Yet Large Numbers Are Also Skeptical. Harris Interactive, Inc. October 26, 2005. Retrieved from http://www.harrisinteractive.com/news/allnewsbydate.asp?NewsID=983, November 5, 2006.
Arthur St.
What about the idea of adding a tier for the uninsured? Currently we have employer based insurance, public insurance programs such as Medicare and Medicaid, VA healthcare for veterans. In some states, there are special Kidcare programs, too. It seems to me that this is where we get into trouble. Instead of looking at the big picture -- we focus on a small part of the picture and respond to a particular cohort.
How is that working for us?
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