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Research & Commentary: Retail Health Clinics, A Good Option for Patients

March 8, 2016

Access to affordable and convenient health care has become increasingly difficult and costly over the past decade.

stethoscope and insurance docs

Access to affordable and convenient health care has become increasingly difficult and costly over the past decade. Labyrinthine regulations have made it increasingly difficult for primary care physicians, the traditional providers of basic health care services, to operate efficiently while still earning a profit. This is especially problematic because the Association of American Medical Colleges has estimated the United States will face a shortage of 12,000–31,000 primary care physicians by 2025.

Fortunately for consumers, another model – one utilizing retail health care (RHC) clinics – has emerged, and if it is widely implemented, it will simplify the distribution of basic health services, provide needed care at a lower cost, and will improve the convenience of receiving care for patients. Retail clinics, which operate in shopping centers, pharmacies, or multipurpose stores, offer basic acute and preventative care services for patients. According to the Rand Corporation, 88 percent of U.S. retail clinics are located in major metropolitan areas. About one-third of the U.S. urban population can easily access an RHC clinic.

Unlike hospitals or other immediate care facilities, retail clinics offer posted prices for treatments and on-the-spot, fee-for-service billing. They also allow patients to pay for services using traditional health care insurance. These clinics pair well with patients who use health savings accounts (HSAs) to purchase care. Retail health clinics offer an affordable and convenient option for receiving health care services, and they provide patients with greater control over their health care choices.

The retail health clinic market is expected to grow rapidly in the near future. Accenture has predicted 14 percent annual growth of the RHC market through 2017, a 47 percent increase over 2014 levels. By 2017, the number of retail health clinics nationwide may exceed 2,800. With this growth has come some regulatory pushback from state governments, including licensing requirements, restrictions on which services can be offered, age requirements for patients, and rules requiring retail clinics to be owned by a medical professional and not a corporation. For instance, New York and the District of Columbia require RHC clinics to receive approval, commonly known as a certificate of need, from health planning authorities.

RHC clinics take the pressure off of doctor’s offices and emergency rooms by decreasing the burden of patients with minor illnesses and those needing routine check-ups. Nurse practitioners, providers who are well-trained and capable of providing quality care for most common ailments, generally staff RHC clinics. The Rand Corporation estimates approximately “one in five visits to a primary care physician and one in 10 visits to an emergency department are for a problem that can be treated at a retail clinic.”

In a 2014 study, The American Journal of Managed Care found the care provided at retail clinics for specific acute conditions has proven to be at least equal, and in many cases superior, to the care offered by other types of providers. “In a healthcare system which sees 177 million [emergency department visits] and 577 million physician office visits annually, there is significant potential for retail clinics to play an increasingly important role in reducing the burden on our primary care channels.” The authors argue when the high quality of care provided by retail clinics is matched with noticeable cost saving to patients, the promise of retail clinics should not be ignored.

RHC clinics provide an affordable, transparent service without the heavy hand of government to guide it. Laws and regulations governing the safety and transparency of retail health clinics are appropriate, necessary, and already in existence. State legislators need to be careful not to hinder the growth of an industry that has brought affordable and convenient basic health care services to millions by imposing more regulations.

The following documents examine retail health clinics in greater detail. 

Ten Principles of Health Care Policy
https://www.heartland.org/publications-resources/publications/ten-principles-of-health-care-policy
This pamphlet in The Heartland Institute’s Legislative Principles series describes the proper role of government in financing and delivering health care and provides reform suggestions to remedy current health care policy problems.  

The Obamacare Evaluation Project: Access to Care and the Physician Shortage
https://www.heartland.org/publications-resources/publications/the-obamacare-evaluation-project-access-to-care-and-the-physician-shortage
Paul Howard and Yevgeniy Feyman of the Manhattan Institute find population growth, demographic changes, and an expansion of insurance spurred by Obamacare will contribute to a significant shortage in primary care physicians over the coming decade. 

Obamacare’s Impact on Doctors—An Update
http://www.heritage.org/research/reports/2013/08/obamacares-impact-on-doctors-an-updat
In this Heritage Foundation Issue Brief, Alyene Senger outlines several effects of Obamacare on doctors: “Specifically, physicians will be subject to more government regulation and oversight, and will be increasingly dependent on unreliable government reimbursement for medical services. Doctors, already under tremendous pressure, will only see their jobs become more difficult.”  

Studies Show: Medicaid Patients Have Worse Access and Outcomes than the Privately Insured
https://www.heartland.org/publications-resources/publications/studies-show-medicaid-patients-have-worse-access-and-outcomes-than-the-privately-insured
In this Heritage Foundation Backgrounder, Kevin Dayaratna states it is becoming increasingly difficult for Medicaid patients to find access to primary and specialty care physicians. As a result, when Medicaid patients are admitted to hospitals, they often arrive with more serious conditions than those with private insurance. By expanding this broken program, Obamacare will only exacerbate the problem. Policymakers should reform Medicaid to allow recipients access to private insurance in a consumer-driven market, Dayaratna writes.  

States Forgo Special Rules for Commercial Walk-In Health Clinics
http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/01/05/states-let-commercial-walk-in-health-clinics-grow-unregulated
Michael Ollove of Stateline discusses retail clinics and how states are choosing to regulate the new market. 

‘Jiffy’ Health Clinics Save Patients Money and Time, Undermine Obamacare
https://www.heartland.org/news-opinion/news/jiffy-health-clinics-save-patients-money-and-time-undermine-obamacare?source=policybot
Justin Haskins writes in Consumer Power Report about the rise of “jiffy” health clinics and their effects on the health care market and Obamacare. “‘Jiffy’ health care clinics represent one of the fastest-growing sectors of the health care industry, providing quick, convenient, and affordable primary care services without the long waits and higher costs of traditional family practices.” 

Out of the Box: The Future of Retail Medical Clinics
https://www.heartland.org/publications-resources/publications/out-of-the-box-the-future-of-retail-medical-clinics
William M. Sage of the University of Texas–Austin School of Law describes in this article the implications of the retail clinic model for U.S. health care policy and health care reform. 

Easy Access, Quality Care: The Role for Retail Health Clinics in New York
https://www.heartland.org/publications-resources/publications/easy-access-quality-care-the-role-for-retail-health-clinics-in-new-york
Paul Howard of the Manhattan Institute examines whether retail health clinics, also called “convenient care clinics,” have a role in alleviating pressure on overcrowded doctor’s offices and reducing inappropriate emergency-room use, thereby lowering overall health care costs. 

Building a Culture of Health: The Value Proposition of Retail Clinics
https://www.heartland.org/publications-resources/publications/building-a-culture-of-health-the-value-proposition-of-retail-clinics
Deborah Bachrach, Jonah Frohlich, Allison Garcimonde, and Keith Nevitt examine the potential value proposition of retail health clinics and how they can help to build a “culture of health” in the United States. The authors review evidence of the impact retail clinics have had in expanding access to lower-cost, routine, primary care services. The authors also consider the quality of these services and whether they impede or facilitate a continuum of care. 

Retail Clinics, Primary Care Physicians, and Emergency Departments: A Comparison of Patients’ Visits
http://content.healthaffairs.org/content/27/5/1272.full.html
In this study, Ateev Mehrotra, Margaret C. Wang, Judith R. Lave, John L. Adams, and Elizabeth A. McGlynn examine the demographics of a national sample of patients receiving services at retail health clinics, primary care doctor’s offices, and emergency departments, as well as the reasons for the visits. Their results found retail clinics appear to be serving a patient population that is underserved by primary care physicians. 

 

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News at https://www.heartland.org/topics/health-care/index.html, The Heartland Institute’s website at http://heartland.org, and PolicyBot, Heartland’s free online research database, at www.policybot.org

The Heartland Institute can send an expert to your state to testify or brief your caucus; host an event in your state; or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Director of Government Relations John Nothdurft at jnothdurft@heartland.org or 312/377-4000.

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Health Care
Author
Matthew Glans joined the staff of The Heartland Institute in November 2007 as legislative specialist for insurance and finance.