Retail Clinic Trends

Clinics in grocery stores, drug stores and other retail shopping locations–and their kin, the onsite work clinic–threaten to reshape the delivery of much non-emergent care in the United States.  With the care usually provided by nurses, nurse practitioners or physician assistants, and offering a limited set of services, the clinics are a convenient and less-expensive care site for many Americans.  Their use is accelerating, as demonstrated in a recent American Journal of Managed Care article.   (AJMC Article)   Based on data from Aetna for under-age 65 enrollees who lived within 20 miles of a retail facility, clinic use increased almost ten times from 2007 to 2009.

Almost one-third of the enrollees in the sample had at least one retail clinic visit.  There was a seasonal pattern to the visits, with more occurring in winter and fewer in the summer.  The closer the enrollee lived to a clinic, the more likely they were to have had a visit.  Younger members and those with fewer chronic conditions were also more likely users, as were people with higher incomes and women.  The availability and number of physicians in an area  did not appear to be associated with frequency of retail clinic use.   The results are consistent with what would be expected:  convenience is the primary driver of use and younger, healthier adults appear more willing to try the clinics.  Users appear to go back, which might indicate satisfaction.  The results suggest that continued very rapid growth lies ahead.

Thus far, no one has credibly identified quality concerns with the care provided at retail clinics.  There is no question that they are a less expensive alternative than regular physician office visits and certainly visits to emergency rooms or urgent care centers.  Wary at first, insurers now not only tend to cover visits to retail clinics but in some cases to encourage their use by lowering copays.  The clinics undoubtedly have saved a great deal of money both for the plans and for consumers.  The major factor that may hold back their expansion is that no one quite seems to have figured out how to make money from operating a retail clinic.  Their have been initiatives to expand the range of services they provide, which may assist in that effort.  In general the clinics are exactly the kind of innovation needed in health care:  at least equivalent quality at a much lower price.