Physician Office vs Retail Clinic: Patient Preferences in Care Seeking for Minor Illnesses

Ahmed and Fincham’s study demonstrates that patients must realize a cost savings to prefer a nurse practitioner at a retail clinic versus a physician in a private office; moreover, the most important factor in care -seeking decision was appointment wait time.1 This is the first U.S. study “to quantify the relative importance of and the utility associated with the main attributes of retail clinics.” 1 In light of these results, health administrators should be attuned to cost savings and waiting-times when setting private or retail clinic policies.1 Since their initial submission, recent studies have demonstrated a favorable cost-savings or cost-effectiveness of retail clinics demonstrating its value:

• “Overall costs of care for episodes initiated at retail clinics were substantially lower than those of matched episodes initiated at physician offices, urgent care centers, and emergency departments, respectively.”2

• “After adjusting for previous visit history, age, and sex, patients who received care in the retail setting had lower standard costs and lower cost rank than patients who received usual care, respectively.”3

As nurse practitioners, physician assistants, and pharmacists expand their scope of practice, they seek out cost-effective and profit-making target markets (e.g., retail clinics in malls, grocery stores, pharmacies). Deloitte Center for Health Solutions (DCHS) determined there was a 65% annual growth rate in retail clinics between 2000 – 2007.4 At the end of this period the economic downturn started and subdued retail growth4 resulting in less modest growth rate of 10-15%.4 DCHS estimates a second wave of growth around 2013 driven by new sites and services4, such as medication therapy management by pharmacists.

Retail clinics originated in Minnesota where Blue Cross supported the model and started coverage in 2001.5 On July 29, 2008, Blue Cross and Blue Shield of Minnesota instituted an innovative policy for its members: If members use a retail clinic they do not have to pay their co-pay for specific medical treatments, such as “sore throats, ear infections and seasonal allergies, as well as routine vaccinations.”5

Future studies that assess overall health economic outcomes delivered in retail settings and those that consider the limitations of Ahmed and Fincham’s study will not only “improve the robust estimates of utility”1 but positively contribute to the public’s health. The Drummond checklist should be applied to assess the quality of health economic evaluations.6 The quantitative method is cost-effectiveness analysis whereby the Incremental Cost-effectiveness Ratio (ICER) can robustly compare settings: retail clinic vs. physician office.

References
1. Ahmed, A., & Fincham, J. (2010). Physician Office vs Retail Clinic: Patient Preferences in Care Seeking for Minor Illnesses. Ann Fam Med, 8(2), 117-123
2. Mehrotra, A., Liu, H., Adams, J. L., Wang, M. C., Lave, J. R., Thygeson, N. M., et al. (2009). Comparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses. Annals of Internal Medicine, 151(5), 321-328. doi: 10.1059/0003-4819-151-5 -200909010-00006
3. Rohrer, J., Angstman, K., & Bartel, G. (2009). Impact of retail medicine on standard costs in primary care: a semiparametric analysis. Popul Health Manag, 12(6), 333-335. doi: 10.1089/pop.2009.0007
4. Keckley, P. H., Underwood, H. R., & Gandhi, M. (2008). Retail clinics: Update and implications (pp. 16). Washington, DC: Deloitte LLP.
5. Blue_Cross_Blue_Shield_of_Minnesota. (2008). Blue Cross Offers No Co-pay For Use Of Retail Clinics Retrieved March 17, 2010, from http://www.bluecrossmn.com/bc/wcs/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=Latest&dDocName=POST71A_121627
6. Drummond, M. F., Sculpher, M. J., Torrance, G. W., O'Brien, B. J., & Stoddart, G. L. (2005). Methods for the Economic Evaluation of Health Care Programmes (2 ed.). Oxford: Oxford University Press.

Competing interests:   None declared