Regular readers of this site know that I believe strongly that high prices, not high utilization, is the primary health spending issue in the United States, and that therefore I am inclined to look favorably on developments which can lower unit costs. One of those developments is the retail health center. These clinics, found in drugstores, grocery stores and mass merchandise retailers, focus on common, easy to treat, medical needs. There are now around 2000 of these clinics, generating about 6 million patient visits. They almost always cost less for the payer and the patient. But what is their effect on overall health spending? That is an issue explored in a study published in Health Affairs. Somewhat distressingly, the study finds that they probably slightly raise spending. (HA Article) The problem revolves around whether retail clinic visits are fully substitutive for visits to other health care settings like doctor’s offices or ERs, or fully additive, i.e., the patient wouldn’t have sought health care, or somewhere in between. The researchers used Aetna data for matched users and non-users of retail clinics for the years 2010 through 2012. They looked at utilization and spending for 11 low-acuity conditions.
The primary measures were use of sites other than the retail clinics and average annual per person spending on these low-acuity conditions. Retail clinic use has grown rapidly, to about 11 visits per 1000 members in the fourth quarter of 2012; and 3% of all enrollees had at least one retail clinic visit. While users and non-users were matched on various characteristics in the study, it is worth noting that users are more likely to be younger, female, high-income and healthier than non-users. Both users and non-users had 71 visits per hundred members for low-acuity physician office and ER sites in 2010 and no retail clinic visits. From 2010 to 2012, the users went to 69 retail clinic visits per hundred enrollees, while their physician and ER visits dropped to 67 per 100. At the same time the non-users increased their physician and ER visits to 95 per hundred people. The researchers estimated that 42% of the retail clinic use represented substitution for physician or ER use and 58% represented new utilization. Spending among retail clinic users for these low-acuity conditions increased by $35 per person per year for the retail clinic use, while spending on physician visits and ER use decreased $21 per person per year, compared to non-users. Note that this spending analysis is incomplete, as it did not make inferences on effect on drug or hospital spending, or specialist referrals. But just in terms of how these low-acuity conditions are treated, it appears that retail clinic users don’t reduce their physician and ER use on low-acuity conditions enough to compensate for the cost of the retail clinic visits. The actual spending increase is modest, but it is not a decrease.
It should be noted that regardless of the effects on health spending, these clinics likely increase access for many Americans, many lessen loss of productive time from waiting in other settings and appear to deliver quality equal to that in other settings. If the convenience and low cost of retail clinics did not exist, many people might not seek treatment for these low-acuity needs, most of which do require medical attention. The study also did not account for the potential cost of failing to seek quick treatment. Like telemedicine, retail clinics can be an important part of the health care delivery system, and the lower unit costs and other benefits may outweigh any increase in spending.