Basic healthcare may have just gotten easier, albeit controversially. The number of walk-in clinics at drugstores like Walgreens, CVS, Wal-Mart, and Duane Reade has been increasing over the last two years, and very little is slowing down plans to add hundreds more across the country. Recent studies cite shorter waiting periods, lower costs, and instant prescription fills for the clinics, in contrast to more expensive and time-consuming trips to doctors’ offices. The majority of these clinics also accept most health insurance plans, leaving little incentive for on-the-go Americans to wait days or weeks for non-specialized appointments in conventional offices.
The rise in healthcare costs, the decrease in the number able to afford private health insurance, and the inadequate number of primary care physicians across the country have all been building up to this — perhaps inevitable — solution. One can now walk in to any number of seven hundred clinics located in several nationwide drug and discount store chains and be seen, on average, in under twenty-five minutes. While the clinics are not recommended for anything but basic care — such as treating a cold, flu, or mild infection — that’s just fine for many, especially those going back to school, who are often bombarded by common, acute illnesses in those first, returning months.
Texas, a state in which twenty-five percent of the populace is without health insurance, may particularly stand to benefit from increased healthcare options. A visit to a MinuteClinic, a wholly owned subsidiary of CVS Caremark, costs an average of eighteen dollars less than other primary-care clinics, according to HealthPartners, a Minnesota health maintenance organization. Emergency rooms across Dallas, Houston, Austin, and the rest of the state are overloaded with the uninsured seeking basic, non-emergency care simply because they have nowhere else to go. Offering easier, cheaper access to basic diagnostic care and treatments may alleviate some of the burden on both individuals and local facilities overwhelmed by too many people and not enough funding.
Twenty percent of people in the United States have no or inadequate access to a primary care physician, with few indications that statistic will improve in the near future. In 2004, seventy-five percent of the counties in Texas lacked sufficient numbers of primary care physicians to meet local needs, and twenty-four counties had none at all. Drugstore clinics often employ more cost-effective nurse practitioners and physician assistants — healthcare workers with the ability to diagnose and treat everyday conditions, but who are under the supervision of a licensed medical doctor. These workers are growing more and more popular within the industry, partially as a result of the shortage of family practitioners.
But doctors’ groups are protesting, and some with good cause. Many of these groups stand to lose substantial business, and are arguing that such facilities may be unable to provide the proper standards of care, including hygiene and safety. “We’ve got big problems in healthcare, and this is not the answer,” said Rick Kellerman, president of the American Academy of Family Physicians.
Many state officials agree, at least to a certain extent. The walk-in clinics are currently being monitored by a confusing mix of agencies applying a wide and inconsistent range of regulations and enforcement principles. After Massachusetts doctors’ groups issued loud protests to the proposed opening of a MinuteClinic, the Health Department issued guidelines for the state, calling for the facilities to clearly specify that they are “limited service clinics.” The American Medical Association is pushing for similar national requirements on the drugstore facilities, urging local and federal governments to require them to be “well-defined and limited [in] scope.” Two public hearings on the issue are scheduled in Massachusetts in September.
Conflicts of interest between the clinics and the drugstores cannot be ignored, either. New York state regulators are investigating possible inappropriate relationships between drug companies and medical providers. The risk, they say, is of healthcare facilities being used improperly to increase business or to funnel patients into their adjacent pharmacies. In certain states, like New York, it is also necessary for clinics to operate as independent practices or professional corporations; i.e., they must not be a part of the drugstore chains themselves.
“If we determine the business corporations [like CVS] are practicing medicine, then they are illegally practicing the profession and we have the authority to investigate,” said Frank Munoz, associate commissioner of the New York State Education Department’s Office of Professions.
Duane Reade, a pharmacy chain located primarily on the East coast, is attempting to limit possible complications by partnering up with well-known hospitals, such as New York City’s Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital Center. Duane Reade clinics will be staffed by medical doctors, versus nurse practitioners or physician assistants, and have admitting privileges to partnering facilities. Such agreements will give the doctors the ability to send those in need of emergency care straight to the hospital, and streamline patients’ procedures to see specialists. Additionally, the clinics will function as private medical practices, run by the physicians themselves, who will lease the space from the corporation.
Michael C. Howe, chief executive of MinuteClinic, which runs over two hundred clinics nationwide, defends CVS’s practices as they are, however. “We are transparent with regulators,” he said, and concerns “are being raised by people who have not really studied the model.”
Being aware of current events and issues affecting your health is an important part of taking care of yourself. Minding your health will certainly affect you as you age, and eventually your wallet.
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