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Friday, April 27th 2007

More Of In Store Clinics

I Trust Wal-Mart For My Health Care Needs

The caption isn’t really fair. Let’s be clear, these in store clinics have major retailers merely acting as landlords.

Change draws criticism. And the fact is these in store clinics are expanding, despite whatever small signs otherwise, and putting new pressures on traditional health care delivery models.

In the latest news Wal-Mart sounds like it wants to forgo the big name commercial in store clinic providers (Take Care, RediClinic, MinuteClinic, et al) in favor of local providers in their bid to open 400 new in store clinics.

Should current market forces continue, the world’s largest retailer said up to 2,000 clinics could be in Wal-Mart stores over the next five to seven years.

Wal-Mart said the effort marks an expansion of a pilot program it started in 2005, when it leased space within its stores to medical clinics. Currently, it said 76 clinics are operating inside Wal-Mart stores in 12 states.

I can’t be an advocate for letting free market forces run rampant across health care (okay, that is a little hyperbole on my position), and find huge fault in these clinics. Clearly they’ll thrive or falter based on the way patients take to them as consumers. Arguments otherwise fall flat:

Retailers contend that the clinics are convenient for consumers and are particularly appealing to the uninsured. I don’t see how a clinic lodged in a big-box retailer is more convenient than a free standing walk-in clinic. And even clinic operators have already found that lower-income uninsured consumers are the slowest adopters of these pay-for-service clinic models.

Proponents of the idea contend that if there wasn’t a demand they wouldn’t be in business. And that’s just not a good enough reason. Internet pharmacies claim they fill a need but are still considered by many to be a bad solution to a struggling health care system. Is cheap, fast and in-and-out in 15 minutes really the best mission statement for a business offering medical care?

But why not? Because it’s impersonal? Because it’s dangerous? An eyebrow raising argument (And yes, I know all the challenges in quantifying preventable patient morbidity and mortality. See here, here, and here).

Look, what is and isn’t an acceptable “mission statement” or business model will, and should rightly be, determined by those making use of it. Not by high thinkers, pundits, and those with potentially conflicting interests. If these NP staffed clinics turn out to be cheaper, more convenient, and provide an acceptable quality then patients will make use of them; if the clinics fall flat on those goals, they’ll fail.

If the medical community’s (and other opponent’s) fear is that these will be forced on patients by third party payers, as a potentially dangerous (but cheaper) alternatives to more traditional medical services, then that is where the argument should be. The argument shouldn’t be over the very existence of these clinics.