Retail health clinics help growing numbers of Americans without health insurance

When patients walk into Barbara Shaw’s small office on North Wells Street, she can never be sure exactly what she’ll be treating them for. Heart attacks, day camp physicals, flu shots and psychoses all walk through the door and take a seat on the same examination table. They’re all charged around $60 for the visit.

Shaw’s office is inside a Walgreens, and Shaw, a registered nurse, is the clinic coordinator at a Take Care Health Clinic. The chain of drugstore clinics, which began operation in 2005, has 28 clinics inside Walgreens stores in the Chicago area. The newest opened yesterday in Rockford.

Take Care isn’t alone in the rapidly growing retail health-care market, however. The Chicago area has 24 MinuteClinics, each inside a CVS pharmacy, and Wal-Mart has also forayed into the health-care market and offered other clinics space in six Indiana locations. There's even a magazine called "Retail Clinician."

The success of these clinics, according to Shaw, is partially due to the growing masses of the uninsured. The number of Americans without health insurance increased 22 percent from 2000 to 2006 to a record 46.9 million uninsured, according to the U.S. Census Bureau.

A routine doctor’s visit for a minor illness can cost more than $100 without insurance: too much for many to afford. Hospital emergency rooms, long a backup for both emergency and non-emergency needs, often include impossibly long wait times and fees that are often a mystery. “People are panicked about not having enough money to pay when they walk in the door of the hospital,” Shaw said.

Retail health clinics are the exact opposite, offering both information about likely wait times and price lists up front. A visit for a minor illness or a physical exam costs about $60. While some vaccinations are more expensive, services rarely cost more than $75. Many insurance plans are accepted.

Although the cost is a motivating factor, many customers say the real benefits come with the convenience, according to Laura Tucco, a family nurse practitioner at the MinuteClinic on State Street.

“You hear it over and over from patients: they can walk in and they can get immediately assessed for treatment,” she said. The clinics are generally open later than most doctor’s offices, as well as on Saturdays.

For customers with regular doctors, the clinics work as intended. When Elmhurst resident Tina Tuszynski, 44, discovered her allergy prescription was about to expire, the wait for a doctor’s appointment was two to three months. Instead, she went to a local MinuteClinic and got a new prescription. “It was a quick way to get my prescription without having to book months in advance,” she said.

But critics of retail clinics are concerned with a model that treats patients only for immediate problems, and may not provide the preventative care that primary health care providers can. There is also the danger of not having a patient’s full medical history.

Although he recognizes the benefits of retail clinics, Brian Klepper, health care analyst, stresses that the clinics are meant to be a stopgap for medical care, not a replacement. “What a retail clinic is not is a medical home,” he said.

He says 95 percent of the time, patients will receive identical care in a retail clinic as in their doctor’s office; there’s a lot of medical precedent for treating an ear infection or a urinary tract infection. The real question, according to Klepper, is: “When it’s not routine, can you properly identify it?”

Clinics say yes. The nurse practitioners who run them are experienced, and can recognize warning signs. “I feel very comfortable with what I do, the limits of my practice,” Shaw said. She often refers patients to specialists and the emergency room. “There have been cases where I’ve picked up high blood pressure and had to send them to the hospital,” she said.

Both Take Care and MinuteClinic use patient visits to educate them about the importance of having a primary care provider, and stress that the clinics are meant as a complement to doctors, not a replacement. At the end of the appointment, patients get a list of physicians in the area, with the hope that they’ll choose one for routine visits and illnesses.

“They’re out filling a void that definitely needs to be filled,” said Dr. John Liu, who treats patients at Adventist Hinsdale Hospital. He doesn’t see low-cost retail clinics as a threat to his practice.

“Given the chance or given the choice, most people would rather see their doctor,” he said. “[Are clinics] a good bridge between sickness and when you can see your primary care physician? Absolutely.”