Are retail clinics an opportunity for expanded access to care or unnecessarily running up costs?

New forms of delivery of health care are generally viewed as a positive move towards a future where access to health care, through the use of different delivery models, is greatly increased. Yet a new study has suggested that one new form, the retail clinic, is actually unnecessarily running up costs of health care and contributing to the rising costs of health care nationally.

JAMA/RAND study

According to a new study conducted by the RAND Corporation and published in Health Affairs, “retail clinics have been viewed by policy makers and insurers as a mechanism to decrease health care spending, by substituting less expensive clinic visits for more expensive emergency department or physician office visits.” However, according to the study, visits to retail clinics may actually be increasing costs because they drive up utilization of health care services.

In order to make this assertion that retail clinics are increasing utilization altogether rather than acting as a substitution for other, more costly types of care, RAND compared insurance claims data from one insurance provider, Aetna, between 2010 and 2012. The researchers focused on 11 different types of “low acuity” conditions, including urinary tract infections, sinusitis, flu, upper respiratory infections, bronchitis, and other unspecified viral infections. These types of conditions represent more than 60 percent of the visits to retail clinics by patients.

Ultimately, the study revealed that 58 percent of visits to retail clinics represented new utilization. Further, those visits were associated with a rise of spending in the form of $14 per person per year. According to the study’s authors the report’s findings “do not support the idea that retail clinics decrease health spending.” The study noted that over 2,000 retail clinics are currently open and that these clinics see more than six million patients overall.

Other issues

Experiences in certain areas show that health care costs are not the only issues associated with the existence of retail clinics. Recently, in New York state, according to the proposed state Senate’s budget, publicly traded companies can operate retail clinics but the state health commissioner will have the power to regulate these clinics. Conversely, the state’s Assembly’s budget does not allow these companies to operate such clinics. Both the budgets would “limit any clinic’s role to acute care, or preventive care, essentially depriving the clinic of any long-term customers, or patients who want help managing a chronic disease,” according to local sources.

These sources note that the state legislature is attempting to limit the role of retail clinics for several reasons. First, “the fear is that patients, whose care is being managed by a large health care, will seek the convenience of a retail clinic for diseases that the health system’s care manager should know about.” This notion, according to the local source, threatens the functioning of the value-based payment models. Further, the legislature is concerned that the clinics could undermine pediatrician offices and could overprescribe medications. Both legislative house budgets in the state attempt to limit the role of the retail clinic for these reasons.