Health care reform is one of the most significant public policy issues facing the United States. The debate frequently focuses on government policy and programs, often to the exclusion of non-government solutions. In this article, part of an occasional series, Sean Parnell reports and comments on how individual citizens, associations, and for-profit companies are solving health care problems through markets and voluntary action rather than government.
Getting access to health care can be difficult for many people, even for individuals or families with comprehensive health insurance. Doctors’ offices are not always conveniently located, requiring a special trip to see the doctor. Many patients cannot see their doctors the same day, or even the same week, they call to schedule an appointment. And most patients are familiar with long waits in a reception area until their doctor can see them.
In addition, visiting a doctor for relatively minor symptoms or ailments can be expensive, even with comprehensive insurance coverage.
To address such concerns, nurse practitioners have begun to set up shop in locations more convenient for patients, typically a busy retail store like Target or CVS Pharmacy, or in a shopping center. These clinics offer a low-cost alternative to doctors’ offices. No appointment is required.
Convenient for Minor Ailments
MinuteClinic, based in Minneapolis, is the biggest operator of these types of clinics, with 22 locations–15 in the Twin Cities area and another seven in Baltimore. FastCare operates two clinics in Louisville, Kentucky, both in Kroger’s grocery stores. Other clinics with names like Quick Care and MEDspot also have opened, and further expansion is expected.
The nurse practitioners staffing these clinics have a four-year bachelor’s degree in nursing as well as a two-year master’s degree. A nurse practitioner is allowed by most states to prescribe medication and perform basic health care functions without direct supervision by a doctor.
At these clinics, nurse practitioners commonly treat such ailments as ear and eye infections, strep throat, allergies, bladder infections, and flu. They also administer vaccinations and perform routine screenings such as pregnancy and allergy tests.
Prices Low, No Waiting
Prices at clinics staffed by nurse practitioners are typically far less than what a doctor’s office might charge. The average cost for a visit is roughly $38 at a FastCare clinic, according to an October 14, 2004 CBSMarketWatch.com article. MinuteClinic’s Web site lists the cost of a visit at about $44.
The February 1, 2004 issue of Fortune magazine compared costs between MinuteClinic and local doctors for several common medical problems. Forbes reported an ear infection treated at MinuteClinic would be $44, while a visit to a doctor’s office would typically cost about $85.
Lower cost is not the only advantage the nurse practitioner clinics offer. Their biggest advantage, according to many in the industry, is the minimal waiting times. There are no appointments: Patients simply walk in to the clinic and are seen almost immediately. The typical visit takes about 15 minutes.
The arrival of clinics staffed by nurse practitioners has drawn mixed reaction from the medical community. Some doctors have expressed concern nurse practitioners will miss the signs of more serious illnesses that require attention from a physician or even a hospital.
Dr. Bob Hamilton, a retired general surgeon in Godfrey, Illinois, says nurse practitioners simply don’t have the extensive medical training needed to identify and treat patients who may appear to have a simple condition but in fact are much sicker and need a doctor.
“Long years of medical training for doctors are spent learning the intricacies of human diseases and their management,” said Hamilton. “The breadth of medicine can be almost overwhelming, but it’s necessary to properly diagnose and treat patients. I’m afraid nurse practitioners simply don’t have that needed training.”
MinuteClinic’s Linda Hall Whitman disagrees. “The doctors expressing these concerns do not appear to be familiar with the depth of the extensive training, credentialing, and national certification required of nurse practitioners,” she said.
“Every MinuteClinic patient assessment and treatment follows evidence-based clinical practice guidelines that are embedded in our electronic medical records system,” noted Dr. James Woodburn, chief medical officer for MinuteClinic, in a company news release. “Individuals with illnesses outside our scope of services or who exhibit signs of a chronic condition are referred to their doctor or, if critical, the nearest emergency room.”
Some critics are also concerned that competition from clinics run by nurse practitioners will affect the finances of physician practices. Lou Giancola, president and CEO of South County Hospital Healthcare System in Rhode Island, recently wrote in a column posted on its Web site, “MinuteClinics … add to the financial strain already felt by hardworking practices.”
Giancola continued, “MinuteClinics cannot provide the continuum of care that your family doctor can, but it can chip away at his or her ability to maintain a practice in this community.”
Clinics ‘Fill a Need’
Other doctors are more comfortable with the role these clinics play. Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons and an internist in Tucson, Arizona, sees a place in a market-driven health care system for standalone clinics run by nurse practitioners, although she has concerns about quality of care and the possibility that better-qualified doctors may be driven out of the market by lower-cost nurse practitioners.
“Things work well in a free market, so I’m fine with patients going to see a nurse practitioner,” Orient said. “Some nurse practitioners are excellent and do a better job than a lot of doctors.”
Linda Gorman, director of the Health Care Policy Center at the Independence Institute, a Colorado think tank, also supports the idea of independent nurse practitioner clinics. “These clinics fill a need for people who know what is wrong with them,” Gorman said, although she also noted, “They aren’t suitable for people with complex medical problems.”
Gorman recounted the story of a friend, a teacher in a school in which nearly all of the students came down with pink eye. “Then the teacher’s eyes turned pink. It was blindingly obvious that she, too, had pink eye. She was not happy having to pay $75 for a visit just to get the prescription. A nurse practitioner clinic would have been perfect for her.”
Nearly All Patients Satisfied
Independent clinics run by nurse practitioners are unlikely to be a “silver bullet” for health care. As many doctors note, the training and experience of nurse practitioners is simply not equivalent to that of a doctor.
However, as Hall Whitman of MinuteClinic observes, treatment protocols at the company’s clinics are reviewed and approved by physicians, and the clinics have a 99.9 percent patient satisfaction rate over four years of operation–treating more than 220,000 people. The firm never has been sued for malpractice, notes Whitman, which would seem to indicate its clinics are focused on ailments within their scope of care and are referring patients to doctors when more extensive diagnosis and treatment may be warranted.
Sean Parnell ([email protected]) is vice president-external affairs for The Heartland Institute.
For more information …
For other reports on innovative private-sector solutions to health care needs, see “Medical Sharing Societies Offer Affordable Alternative ‘Insurance’,” Health Care News, September 2005, http://www.heartland.org/Article.cfm?artId=17709
“Insurance-Free Pharmacies Lower Consumers’ Drug Costs,” Health Care News, February 2005, http://www.heartland.org/Article.cfm?artId=16437