The New Health Dialogue

Convenience stores. Convenience food. Convenience … care?

Yes. Retails clinics, a new model for ambulatory care that emphasizes patient convenience, have popped up all over the country. There are currently 1,000 retail clinics throughout the United States and RAND expects to see 6,000 by 2011. These one-stop medical shops are generally found in stores such as Target, CVS, and Walgreens (these three stores own 73 pecent of all retail clinics). With catchy titles like "Minute Clinic: You're Sick, We're Quick," the clinics contribute to a culture of convenience and offer a new way to deliver basic health care services. No appointment necessary, open nights and weekends, and wait times are minimal.

Retail clinics may be a convenient and quick solution, say, if you have a terrible ear infection on a Saturday or come down with a sinus infection Monday night. But they have certainly caused some controversy within the medical community. Can health providers at these sites make accurate diagnoses? Provide appropriate follow-up care? Interrupt physician-patient relationships?

RAND Corporation has conducted several studies analyzing the role of retail clinics. Among the findings, RAND researchers concluded:

Patient Population. Retail clinics typically attract insured and uninsured patients who need basic care and do not have a regular care provider. Compared to patients seen by primary care physicians, retail clinic patients are more likely to be young adults (ages 18-44).

Locale. Most (88 percent) of U.S. retail clinics are found in major metropolitan areas. They are most likely to be located in areas with lower poverty rates and higher median incomes; they are less likely to be located in medically underserved areas.

(SOURCE: Rudavsky, Pollack, and Mehrotra, 2009.)

Quick and Simple. About 90 percent of visits to retail clinics are for 10 simple acute conditions and preventive care: upper respiratory infections, sinusitis, bronchitis, sore throat, immunizations, inner ear infections, swimmers ear, conjunctivitis, urinary tract infections, and either a screening test or blood test. The care is generally delivered by a nurse practitioner. Typically, people go to retail clinics for problems when they value convenience over a strong and on-going relationship with a primary care physician. About one in five visits to a PCP and one in ten visits to the emergency department are for problems that can be easily treated at a retail clinic.

Preventive Care. Some worry that retail clinic patients miss out on the critical preventive, follow-up and on-going care that goes along with having a regular primary care physician. Just 39 percent of patients at retail clinics said they had a regular primary care physician, while 80 percent of people surveyed across the nation report having a PCP. Research does not indicate that retail clinics adversely impact preventive care. Moreover, retail clinics can't disrupt a physician-patient relationship that never existed. 

Cost. For a select group of conditions, retail clinics provide lower-cost care at equal quality when compared to care delivered at other health care settings. 

Insurance Coverage. Patients visiting retail clinics back when they first opened were likely to pay for the care out-of-pocket, but now, patients are using insurance to cover their bills. The percentage of retail office visits paid for out-of-pocket dropped from 100 percent in 2000 to 16 percent in 2007.

Provider Shortage. Most of the conditions retail clinics address do not require the level of training of a physician. With a shortage of physicians (specifically, in the primary care field) and overburdened emergency departments, retail clinics could alleviate some of the stress on both of these care settings.

The findings, while not conclusive, provide a framework for the medical community as they work to determine the value, effectiveness and function of retail clinics. “There is a lot of curiosity and questions about retail health clinics because they are a new way of providing care in a system of health that has seen little change over the past 50 years in how care is delivered,” said Dr. Ateev Mehrotra, a professor at the University of Pittsburgh School of Medicine and researcher at RAND.