(MintPress) – Retail health clinics – also known as convenient care clinics (CCCs) – have been spreading exponentially since they first came on the scene in the U.S over a decade ago. They are cropping up in grocery stores, pharmacies and big-box stores across the United States. Some say they fill an important role in providing timely health care, and sometimes for the under- or non-insured.
However, the rapid growth of these clinics, which are for-profit enterprises, has also raised caution among some health promotion advocates.
Retail Clinics Serve an Underserved Population
A 2009 National Institutes of Health study finds that retail clinics appear to be serving a patient population underserved by primary care physicians (PCP’s).
“For consumers who do not have established physician relationships, including many of the 47 million uninsured and 30 million underinsured Americans, CCCs offer a critical access point for care,” the Conveinient Care Association points out. “Approximately 30 percent of CCC patients report that they do not have a regular source of primary care.”
Convenient care clinics are small storefronts or sections of larger commercial businesses that provide a menu of basic health services – at a price – to anyone who walks in for care. They are also sometimes referred to as “walk-in” clinics.
Many of these clinics post their services as well as prices on a roster at each site, and often the information on pricing is available online as well.
Frequently cited reasons for use included treatment of a cold or other minor illness (39 percent), flu shot (19 percent), immunization (8 percent), and other minor procedures (35 percent), according to a 2012 NPR-Truven Health Analytics Health Poll detailed on NPR.com.
Generally these basic services cost in the $40 to $60 range and, in many cases, are limited to adults. Examples include: sinus infections, strep throat (extra for a lab test), earaches, pink eye, insect bites, minor burns, vaccinations, pregnancy testing, abrasions and sprains.
The survey also found that 57 percent of participants paid less than $25 at the time of their clinic visit. In addition, 65.2 percent of participants reported that their visit was covered by health insurance.
The first retail clinic opened in 2000 in Minneapolis. Today, over 1,500 operate nationwide, many in retail pharmacies such as Walgreens or CVS and others in groceries or big-box chains like Target. Some are stand-alone clinics in malls. The NIH estimated that the number of clinics will grow to almost 6,000 in the next five years.
Almost 20 percent of people in need of health care need to wait at least a week to see a doctor when they are sick. A same-day appointment, an appointment before or after work, or an appointment with a traditional doctor’s office on a weekend is challenging, if not impossible for many Americans. Hence, the appeal of such clinics.
Criticism of CCCs
Retail clinics have been the subject of considerable controversy in the U.S. since opening over a decade ago, with physician organizations, such as the American Medical Association, the American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP), which have raised concerns about whether health professionals operating at these sites make accurate diagnoses and appropriate triage decisions and whether retail clinics potentially disrupt existing physician-patient relationships, the NIH study points out.
Moreover, once insured patients try retail clinics for simple acute conditions, they are much more likely to rely on them for similar issues in the future, according to a study published in October in the Journal of General Internal Medicine. Because of that, continuity of care can be broken, and any practice near a retail clinic needs to make sure information on their patients is transferred.
“The average primary care physician is not going to see much of a difference in their practice volume if a retail clinic opens in the area, but for some aspects of primary care, we do find a negative impact on the patient-physician relationship,” said Dr. Ateev Mehrotra, an associate professor at the University of Pittsburgh School of Medicine and the study’s lead author.
“In some states and localities, regulators are fearful that it represents a compromise to safe and effective care. In many communities, local physicians have actively campaigned against retail clinic openings and advised patients to seek care elsewhere,” writes Paul Keckley, executive director for the Deloitte Center for Health Solutions in a 2009 study “Retail Clinics: Update and Implications.”
“There is concern whether retail clinics may disrupt the relationship between patients and their personal physicians, which may make it difficult to maintain the quality and continuity of medical care,” Mehrota says.
“Some might contend that continuity is the cornerstone of primary care and, therefore, retail clinics’ negative impact on continuity is critical,” the authors wrote in the study. “Others might argue that continuity and first-contact care are less important than preventive care, especially for a health patient population. In this light, retail clinics’ impact on primary care may not be as great as feared.”
However, since these types of clinics continue to make an impact, for better or worse, on the American health landscape, we will need to gather more information on how such clinics affect actual health outcomes, the researchers concluded, and about how they are used by publicly insured and uninsured patients before we can judge how primary care is really affected.