Wednesday, February 20, 2008

Move Over Romney, Wal-Mart's in the House

Forget RomneyCare...or HillaryCare...(but I repeat myself.)

It’s Wal-Mart to the rescue!

Yes, that’s right. The free market is doing what it always does: innovates new solutions to old problems and meeting societies needs.

Wal-Mart can be good for your health

But the medical industry doesn’t like it.

Many medical groups, like the American Academy of Family Practice and the American Academy of Pediatrics (to which I belong), have published position papers opposing retail clinics. Their basic argument is that retail clinics run counter to the concept of "a medical home," a place where patients receive care for any and all of their problems. They worry that patients will have no sensible place to follow up their test results, and that putting a clinic in a mall or a Wal-Mart could expose shoppers to people with a contagious illness.

The medical community needs a second opinion. Retail clinics are good for American healthcare. By giving doctors a run for their money, they force us to do something we don't do well: innovate. At their best, retail clinics can make doctors look like smart entrepreneurs instead of a self-interest group futilely trying to protect archaic ways of doing business.
Of course they don't like it. Competition is cutting in on their turf. Boohoo.

When we discuss the problems in Healthcare today, most people (ignorant of basic economics) believe that it’s the nature of the marketplace to blame, and can imagine the only solution being one set forth by government. But the fact is, the marketplace is not to blame. We are in the position we are in because of past government interventions in the marketplace. From the cartelization of the healthcare and drug industries through the over-empowerment of HMOs and the insurance industry, costs have skyrocketed and access has dwindled. To boot, these groups (like all others who feed at the government trough) have powerful incentives to protect their special-priveleges.

But the free market is unstoppable. As long as there is breathing room, the market will develop ways that will provide some relief from State-caused problems.

Enter low-cost, drop-in retail clinics.

On the other hand, retail clinics are thriving. They provide excellent access. After all, what's more convenient than showing up any day, night or weekend to have your sore throat checked? No telephone time spent on hold trying to make an appointment, no shuffling your personal schedule to get there.

Then there's cost. Retail clinics operate on a fee-for-service basis and don't accept insurance. Most charge a maximum of $50, which is significantly cheaper than the $100-plus your insurance company (or you, if you carry an increasingly popular high-deductible insurance plan) will pay when see your doctor for the same concern. That relative savings makes retail clinics a great place to go if you're uninsured and have a minor medical problem.

And how do consumers like this alternative? They LOVE it.

This desire to pay out of pocket is a not-so-subtle sign that consumers are asserting their purchasing power in the health sector, just as they would with other goods and services. A 2005 Wall Street Journal/Harris poll confirms this: Eighty percent of retail clinic users expressed satisfaction with the cost of services; 89 percent were satisfied with the quality of care; 88 percent, with the staff's qualifications (usually nurse practitioners).
And there are many reasons for this successful model.

The success is due to a few reasons. First, retail clinics don't do everything. Literally, a customer has to choose what he or she wants from a menu of choices posted on a marquee. Choices are limited to simple, easy-to-handle medical problems like sore throats, allergies and cold sores or a request for routine flu or pneumonia vaccinations. No acute medical problems, like injuries or asthma, are addressed. All decisions are made using very strict decision trees, leaving no room to treat issues beyond or outside of them.

Clinics make no claim to be a medical home. Statistics support the safety of this approach. The CEO of MinuteClinic, the largest of the retail clinic chains, said in 2007 that they have never had a patient show up with chest pain, and that fewer than 10 percent of patients are turned away. Also, there's nothing complicated about communicating with a patient's primary doctor. Specialists and emergency rooms routinely send letters or faxes to primary care offices to inform them about a patient, his or her diagnosis, prescribed treatments and a follow-up plan. Retail clinics have made efforts to do the same. So rather than writing position papers opposing retail clinics, medical organizations ought to use them to encourage bold innovation.

God bless the free market.

Let’s just hope that the State-Worshippers in both parties stand back and let the market do its work. Marketplace innovation is what is needed, and will ultimately be what helps reduce and eliminate the problems we face today. What we don’t need is Mitt Romney style socialism.


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