Retail Health Clinics Result in Higher Spending, Survey Finds

2 years ago
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Insurers and employers are eager to have workers explore new ways of getting care, like visiting a clinic at a drugstore when they have a sore throat. The care they receive not only is more convenient, but also costs much less than a visit to the emergency room or a doctor’s office.

But a new study published on Monday in Health Affairs, a policy journal, casts fresh doubt on whether these popular retail clinics will save money. Researchers concluded that the clinics led to slightly higher spending because people used them for minor medical conditions they would typically have treated on their own.

The higher use, researchers said, outweighed the savings that resulted when people went to a cheaper retail clinic instead of to the doctor or emergency room.

The study looked at insurance claims data from Aetna, a large health insurer, for minor conditions. The researchers calculated that 58 percent of retail clinic visits were for services that they would not have otherwise sought, resulting in a net increase in spending of $14 per person per year.

“Convenience has an Achilles’ heel,” said Dr. Ateev Mehrotra, the study’s senior author, who is an associate professor of health policy at Harvard Medical School and a researcher at the RAND Corporation, a nonprofit research group.

Executives at retail clinics say the study was flawed and failed to demonstrate the overall savings the clinics achieve. The study’s authors acknowledge that the study did not offer conclusions about whether the visits to the clinics prevented hospital stays or reduced the need for a prescription, a goal for policy analysts that has the potential of reducing overall health spending.

The study does not take into account the role the clinics play in treating people early, said Dr. Andrew Sussman, president of MinuteClinic, the retail clinics operated by CVS Health, the drugstore chain. “These patients are not going to get better on their own,” he said, and a clinic visit can prevent a very expensive hospital stay.

Dr. Sussman pointed to his published research, looking at CVS’s employees and evaluating their use of retail clinics, that showed overall savings, including fewer hospitalizations.

Still, the findings raise serious questions about whether new sources of care like clinics or telemedicine, in which medical advice is offered over the phone, will be able to save money. People may find it much easier to pick up the phone or go to a drugstore without an appointment to have a minor ailment checked.

There are some 2,000 clinics across the country, according to the researchers, accounting for more than six million visits a year. The clinics are distinct from urgent care centers, which tend to offer more sophisticated tests and treat more complex conditions.

In general, people go to retail clinics for simple conditions. A child may be running a high fever or someone with a bad sore throat may want to rule out something more serious.

Aetna, which did not fund the study but provided the insurance claims for it, says retail clinics provide a useful service. “Retail clinics are a convenient and flexible option that are available during extended hours, while traveling, and for minor health needs,” Kristine Grow, a spokeswoman for Aetna, said in a statement. “They are also a good option for consumers who do not have a primary care physician, and a far better setting for care than an emergency room.”

The question of whether the centers may reduce costs by improving care for people with chronic conditions like diabetes and asthma remains unanswered, she noted, and more analysis needs to be done to determine whether they save money in other ways.

Much of the care provided by MinuteClinic is preventive services like vaccines, said Dr. Sussman, who said the clinics were also a resource for people who did not have a regular doctor.

Retail clinics may also serve an important function by forcing doctors and hospitals to respond with lower prices and expanded hours if they want to retain patients, said Martin Gaynor, a health economist at Carnegie Mellon University who is also one of the study’s authors.

But convenience may still have a price, Dr. Mehrotra said. “All of those things are going to increase utilization,” he said. The question, he said, is “Are we getting the worried well or the sick?”

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