Walk-in health care in California

Free-enterprise facilities offer quick, not-too-costly help -- way ahead of the government mess

While state and national leaders debate a cure for a broken health care system, a band of entrepreneurs has been quietly responding with a stab at the problem: establishing walk-in, storefront clinics. These clinics, often tucked into pharmacies, keep retail hours and offer a menu of services: diagnosis and treatment of routine ailments like sore throats, pinkeye and swimmer's ear, vaccinations and health screenings. The Sacramento region already has three retail-based clinics, with four more scheduled to open soon. They are part of a nationwide trend in health care delivery: easy-access medical services for customers willing to pay for the convenience. Backers say they cater to people who want health care that is uncomplicated, quick and not too costly.

That description fits Wendy Holmquist, a 36-year-old mother of two with a full-time sales management job and little patience for long waits at doctors' offices. "I feel like hell," Holmquist told a nurse practitioner recently inside a one-room clinic at the back of a Natomas Rite Aid pharmacy. "I can't even bend over because of the pain in my face." A half-hour later, Holmquist left the clinic with everything she needed: a diagnosis of a sinus infection, an antibiotic and decongestant, and nurse's orders for steamy showers and liquids. For Holmquist, who lives north of Sacramento but whose regular doctor's office is in east Sacramento, the clinic's slogan -- "Real Health Care, Real Quick" -- proved to be prophetic.

"Obviously, consumers are driving this," said Tine Hansen-Turton, executive director of the Convenient Care Association, a nationwide trade group formed to support and establish guidelines for the fledgling industry. "There are 46 million uninsured in this country and many complaints about bad experiences with the health care system," Hansen-Turton said. "Consumers say, 'This is a model we like because the clinics are available when we need them and on our terms.' That's different." Health care consultant Mary Kate Scott calls it an "irreversible trend," citing rapid growth -- from 62 clinics nationwide at the start of 2006 to 235 by year's end -- and projections for at least 500 more this year and another 700 in 2008.

Besides the Natomas site, Sutter Express Care now operates clinics at Rite Aids in Rancho Cordova and Elk Grove. Another, on Florin Road, will open Thursday, followed in late February or March by Rite-Aid-based clinics in Folsom and Roseville.

Later this month, Sacramento internist and KCRA television health correspondent Dr. Thomas Hopkins will open his own business, Medi-Stop, a routine-care clinic in a 1,200-square-foot space at a Natomas strip mall. A chronic shortage of primary care doctors, an aging population and higher out-of-pocket costs for insured patients fuel the movement, Scott said. The trend attracts consumers too busy or tired of waiting on the phone with their HMO's on-call nurse for an appointment that may not come anytime soon. "As consumers start to pay more and more, they get more discerning and play a more active role," said Scott. "They are really responding to increased access and the cost-effective approach."

The retail clinics may appeal to people with high deductibles, those who can't get insurance or opt not to purchase it, or people who otherwise may go to emergency rooms. But they are also popular with insured patients who simply seek convenience. Sutter Express Care, for example, accepts most types of health insurance, including Medicare for seniors. That meant that Holmquist, who was prepared to pay the standard $59 fee for the visit, was charged only a $15 insurance co-payment.

The model won't work for everyone, though. Fifty-year-old Phyllis Owens, whose chronic health problems prevent her from working, relies on Medi-Cal, the state's insurance program for the poor and disabled, for her care. Neither Sutter Express Care nor Medi-Stop are set up to bill Medi-Cal for services. "Sixty dollars is a lot of money," said Owens, who complained of an aching back while standing outside an Oak Park grocery store. "It would be wonderful if it cost $10."

Nationally, supermarket chains such as Piggly Wiggly, and big box outlets such as Wal-Mart and Target also offer clinics. In the Bay Area, Farmacia Remedios, a small chain with in-store clinics, caters to Spanish-speaking customers. "Over the past three or four years, access to basic health care has become a big problem," said Hopkins, whose Medi-Stop clinic is sandwiched between Carvel Ice Cream and and Computer Renaissance. "We want you to come in, get what you need, and get follow-up somewhere else if you need to."

A Harris Interactive poll reported high satisfaction from those who used the clinics, but a majority surveyed also worried that serious medical problems might not be accurately diagnosed. The medical establishment has similar concerns, since retail-clinic physicians only serve in supervisory roles and typically are not on-site. The American Medical Association has outlined nine principles it says will ensure that patients of the clinics get the best possible care. It recommends, for example, that clinics limit the scope of their services and that patients are informed they will be seen not by a licensed physician but a specially trained nurse or physician assistant. "There is more to it than simply patient satisfaction," said Dr. William A. Hazel Jr., an AMA board trustee. "The value will depend on being able to demonstrate they delivered quality care in a safe and effective fashion."

Although the California Medical Association has not officially weighed in on the phenomenon, CMA President Dr. Anmol S. Mahal worries that expanded use of the clinics could damage the "sacrosanct" doctor-patient relationship. "In primary care, our physicians don't just treat the earache that day, but they know the person," said Mahal, a Fremont gastroenterologist. Dr. Thomas Atkins, a family physician and the medical director for Sutter Express Care, said the clinics are not trying to offer a substitute for regular primary care. The retail-based clinics also work as referral services, turning away patients with head trauma, serious lacerations or complications from chronic diseases.

At Sutter Express Care, nurse practitioner Lynn Denham-Martin keeps a file with names of community doctors accepting new patients, as well as locations of other types of clinics, including Planned Parenthood for obstetrics, gynecology and primary care, and Med 7 Urgent Care, a stand-alone center equipped with a lab and X-ray and staffed with physicians who can address broken bones and many serious illnesses. At the Sutter Express Care clinics, and at the soon-to-open Medi-Stop, patients choose from a "menu of services," a list of easily treated ailments from seasonal allergies and strep throat to sprains and sunburn.

Rite Aid spokeswoman Jody H. Cook said that, in an era when the traditional pharmacy has a small profit margin, clinics can bring more customers -- and dollars -- into the drugstore. That formula worked with clinic patient Lynn Davis of Sacramento. While waiting for a decongestant prescribed by Denham-Martin, she hunted the aisles for soda for her husband and food for her cat before heading home. "It's awesome," Davis said. "Convenience. That's the key."

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Australian man dead for 10 months given surgery date

It's getting as bad as Canada!

A man who has been dead for almost a year was scheduled for surgery today at Queensland's biggest hospital. The blunder has stunned grieving mother Ann Heath, 66, who says her son Michael Trindall, 45, should never have been on a public waiting list.

Mrs Heath was bracing herself for the first anniversary of her son's death when the Royal Brisbane and Women's Hospital sent a letter in December to advise the date of his surgery. "What can anyone else to do me? I have lost my son and I have to put up with this garbage," Mrs Heath said.

The revelation comes just weeks after Premier Peter Beattie announced the Government would tender for a broker to manage its public hospital elective surgery waiting lists and a short time before the latest waiting list surgery data is released. It's also nine months since Mr Beattie claimed the state's health system had "turned a corner".

Mrs Heath, who received the letter four days before Christmas, said she was overcome by anger. She said it was ironic that as thousands of people wait for public surgery, Queensland Health booked a time for her dead son, who died at the Gold Coast's John Flynn Private Hospital last February.

A spokesman for Health Minister Stephen Robertson said Mr Trindall was due for his annual check-up with a urologist. But Mrs Heath said her son had private health insurance and although he received chemotherapy for his pancreatic cancer at the RBWH, all other procedures were done at private hospitals. "And besides, he had pancreatic cancer, he didn't have anything wrong (for which he would need to see a urologist), and he was already dead. There's no excuse," Mrs Heath said.

In a statement to The Courier-Mail, a Queensland Health spokeswoman said: "This is an extremely regrettable but unavoidable situation. "(The) RBWH was not notified of the patient's death (and) it is simply not possible to track all patients, including those treated in private facilities. "In this instance, Queensland Health had no way of knowing of the patient's death. "A letter of apology and an explanation will be sent to Mrs Heath."

Mrs Heath has accused the Government of incompetence and insensitivity and has asked her local Liberal MP Jan Stuckey to get some answers. Mrs Stuckey, a former nurse and wife of a GP, said the case highlighted how shambolic the public system still was. "She wants to know why Michael's name appeared on the waiting list when he had passed away 10 months prior," Mrs Stuckey said. "Mismanagement and incompetency of our public health system is both legendary and shameful. "Patients hope they live long enough to get on to the waiting list, and then it could easily be the wrong patient."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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