Customer Health Care


WSJ COMMENTARY

By GRACE-MARIE TURNER
May 14, 2007; Page A17

It's Friday evening and you suspect that your child might have strep
throat or a worsening ear infection. Do you bundle him up and wait
half the night in an emergency room? Or do you suffer through the
weekend and hope that you can get an appointment with your
pediatrician on Monday -- taking time off your job to drive across
town for another wait in the doctor's office?

Every parent has faced this dilemma. But now there are new options,
courtesy of the competitive marketplace. You might instead be able to
take a quick trip on Friday night to a RediClinic in the nearby Wal-
Mart or a MinuteClinic at CVS, where you will be seen by a nurse
practitioner within 15 minutes, most likely getting a prescription
that you can have filled right there. Cost of the visit? Generally
between $40 and $60.

These new retail health clinics are opening in big box stores and
local pharmacies around the country to treat common maladies at prices
lower than a typical doctor's visit and much lower than the emergency
room. No appointment necessary. Open daytime, evenings and weekends.
Most take insurance.


Who needs magazines and crowded waiting rooms?
Much like the response to Hurricane Katrina, private companies are far
ahead of the government in answering Americans' needs, this time for
more accessible and more affordable health care. Political leaders
across the country seeking to expand government's role in health care
should take note.

Thousands of free-standing primary care clinics have been operating
for years in malls and main streets around the country, often staffed
by physicians and many offering a broad range of health services. The
retail health clinics are creating a new model with more limited
services at lower prices and almost always staffed by nurses. The
Convenient Care Association estimates there are about 325 of these
retail clinics operating nationwide today. Seventy-six of them are in
Wal-Marts in 12 states, but the company announced last month it will
expand to 400 clinics by the end of the decade and 2,000 in five to
seven years. They will be run by outside firms, including for-profit
ventures like RediClinic as well as local and regional health plans
and hospitals.

The industry is rapidly expanding. You can find a MinuteClinic in the
CVS on the Strip in Las Vegas. But you also will find many locally-run
clinics in pharmacies and food stores across America, such as the
Express Clinic in Miami, MediMin in Phoenix, and Curaquick in Sioux
City, whose motto is "Get well soon."

Prices vary for services from flu shots ($15-$30), to care for
allergies, poison ivy and pink eye ($50-$60), and tests for
cholesterol, diabetes and pregnancy (less than $50). Competition
already is starting to drive prices down.

Of all patients who have visited the clinics, almost half went there
for a vaccination, and one-third received treatment for ear
infections, colds, strep throat, skin rashes or sinus infections.
Ninety percent said they were satisfied with the care they received.
The nurses staffing the clinics are under physician supervision and
follow strict protocols to refer patients to physicians or emergency
rooms if problems are more serious.

Internists and family doctors are watching. Some see the clinics as
useful in providing efficient care for a limited number of
uncomplicated ailments, freeing physicians and hospitals to deal with
more complex cases. But others are worried about lost business,
fragmentation of care, and the quality of care if the clinics miss
something serious.

Rick Kellerman, president of the American Academy of Family
Physicians, concedes, "The retail clinics are sending physicians a
message that our current model of care is not always easy to access."
The threat of competition from the in-store clinics means some doctors
are keeping their practices open later and on Saturdays and holding an
hour open for same-day appointments. Competition works.

And competition also worked to force prescription drug prices down:
When Wal-Mart announced last year that it was dropping the price of
several hundred generic medicines to $4 for a month's supply, other
pharmacies, from Target to corner drug stores, followed suit. Wal-Mart
now says that a third of all prescriptions filled at its pharmacies
are for the $4 generics, and 30% of them are filled by people without
insurance.

Take note, Congress: The market is providing cheaper medicines, more
affordable care -- and it is also helping the uninsured. A Harris
Interactive poll conducted in March for The Wall Street Journal said
that 22% of those visiting the clinics were uninsured. Wal-Mart says
that half of its clinic visitors are uninsured.

Retail clinics are particularly attractive to 4.5 million people with
Health Savings Accounts who have health insurance with higher
deductibles and want an affordable option for some of their routine
care.

And the clinics are working to solve another problem that is vexing
Washington -- creation of electronic medical records. Most retail
clinics create computerized patient records, with the goal of making
the records accessible throughout the chain. The records also can be
emailed to a hospital or to the patient's regular doctor -- or sent by
fax if necessary.

Critics of engaging private competition in the health sector will
argue that the vast majority of health-care dollars are spent on a
relatively small percentage of patients with serious illness,
especially those with multiple chronic conditions.

But even coordination of care for those with chronic illnesses lends
itself to patient-friendly solutions. The City of Asheville, North
Carolina, cut its costs in half for employees with diabetes by teaming
up with local pharmacists who did routine exams and got patients to
their doctors or hospitals more quickly when they needed intervention.
Employees received their medicines for free if they kept appointments,
and their health improved.

Because health care is largely regulated and licensed at the state
level, some states are more friendly than others at having non-
physicians deliver care. California requires that clinics be a medical
corporation owned by a physician. In Arizona, each site must be
licensed, but in most other states, a single license will serve
multiple clinics. Illinois is considering legislation to limit the
number of nurses a doctor could supervise to two and restrict the
clinics' right to advertise.

This industry is in its infancy and will hardly register in our
nation's $2 trillion-plus health care bill. But just as Nucor
overturned the steelmaking industry with a faster-better-cheaper way
of making low-end rebar, these limited service clinics could be the
disruptive innovator in our health-care system. Package pricing for
more complex treatments, like knee replacement surgery, may not be far
behind.

Government can get in the way, of course, with protectionist policies
that throw up more regulatory barriers to entry. But retail clinics
could be just the beginning of consumer-friendly innovations, if
Congress were to change tax policies in a way that would allow people
to have more control over their health spending, as President Bush has
proposed.

The linchpin is giving people the same tax benefits whether they get
their health insurance at work or on their own, or buy coverage
through groups like churches, labor unions and professional or trade
associations. Allowing people to buy health insurance across state
lines would inject another dose of healthy competition into the
system.

With many congressional leaders hostile to free-market solutions,
these policy changes are unlikely in the next two years. But as
consumers get a taste of what consumer-friendly health care is like,
they may well demand that the top-down, centralized health-care
delivery of the 20th century give way to a system more in tune with
the demands of 21st-century consumers seeking greater value and
efficiency.

Ms. Turner is president of the Galen Institute.

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