Health Care Retail Clinics

Affordable, convenient health care has become more available to average Americans as a result of the proliferation of so-called "retail clinics."

A resurgence of the failed effort to establish "store-front clinics" in the 1980s, retail clinics are growing in number across the nation. These clinics, which offer basic acute care services and preventive care options, provide cost transparency to their customers with clearly posted prices and on-the-spot fee-for-service billing. Many clinics accept insurance, as well, charging standard co-payments for care.

Not only do retail clinics provide convenience to consumers -- they are often located in shopping centers, pharmacies, or multipurpose stores like Wal-Mart -- but they also provide a non-emergency room and non-community-clinic option for uninsured Americans to receive preventive care and treatment for minor illnesses.

Retail clinics empower people to take control of, and responsibility for, their own health needs. In-store clinics offer an excellent opportunity for health care reform; policymakers should not only acknowledge their role in health care provision but also be careful not to create laws that stifle these innovations.

Some experts believe the retail clinics are catching on because of the shortage of family physicians. Within the next 15 to 20 years, the deficit is expected to reach as many as 200,000 physicians -- 20 percent of the needed workforce, according to Dr. Richard Cooper, a professor of medicine at the University of Pennsylvania. "The success of the new retail clinics (now) is more likely because there's a doctor shortage," he said.

"[The spread of retail clinics] will mean that [family physicians] will have to evaluate how convenient their practices are for patients, and will most likely need to make some changes to be more user-friendly," said Dr. Larry Fields, president of the American Association of Family Physicians.

The number of retail clinics operating in the U.S. has surged in the past three years, from fewer than 50 in 2005 to more than 1,000 today. These clinics are expected to expand their scope of treatments in upcoming months and years to include chronic disease management, injections (some already offer influenza vaccinations and other injection services), weight loss counseling, and more.

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THE AUSTRALIAN PUBLIC MEDICINE CHAOS CONTINUES

Two articles below

Elderly man dies after waiting 8 hours for a public hospital bed

An elderly man has died while waiting for a ward bed at the overcrowded Townsville Hospital after being left in a corridor for more than eight hours. The man, believed to have had cancer, was monitored by medical and nursing staff during the delay to transfer him to a ward at the troubled hospital.

Health Minister Stephen Robertson yesterday said he had referred the case to the Health Quality and Complaints Commission for independent review. "I view this matter very seriously and that's why I'll be referring this incident to the independent health watchdog," Mr Robertson said. "It's my responsibility to ensure that when events such as this occur that we don't sweep it under the carpet and we get full disclosure in terms of the facts of what actually occurred and learn from them, if there are in fact lessons to be learned."

Several doctors and nurses contacted The Sunday Mail late last week expressing concern at the over-crowding in the hospital. One staff member said it used to be unacceptable practice to have more than eight patients waiting to be admitted to a ward. But, he said, the hospital now had to deal with the tragedy and shame of a patient dying on a trolley in a corridor. "He was very sick, but he waited a very long time for a bed - and didn't get one," said an emergency department nurse, who asked not to be identified, about the man's death last Tuesday. "He was in the corridor with patients on trolleys in front of him and behind him ... he was rushed into the resuscitation room, but he wasn't revived. It's just terrible."

Acting Townsville Health Service District CEO Mary Bonner said the first priority for the hospital was ensuring that the patient's family was informed and supported.

The death comes a week after Mr Robertson dismissed the concerns of Dr Sylvia Andrew-Starkey from the Australasian College for Emergency Medicine. Dr Andrew-Starkey said she had referred information to Queensland Health about people dying because of bed access problems in hospitals. But Mr Robertson challenged Dr Andrew-Starkey to provide evidence of a link between wait times and harm to patients.

Professor Drew Richardson, from the Australian National University, told The Sunday Mail he could direct the minister to two major studies carried out in Australia and two more from America which showed the link. "There are cases where coroners have handed down adverse findings in relation to the outcome of patients who have had to wait for extended periods to be admitted, Prof Richardson said. "There are cases where death has been a direct result of dysfunctional environments in emergency departments."

Townsville Hospital's emergency department was designed to cater for 38,000 patients each year. Last financial year almost 62,000 sought treatment there. The demand has led to up to 24 patients each day remaining in the emergency department, some of them for up to 48 hours, until beds can be found in overcrowded wards.

Doctors and nurses in the department said they no longer provide emergency care as much as determine which patients are most able to cope with a long wait in the corridor. "We do not treat patients anymore. We run around managing an out of control department - it's not because of sick patients. It's out of control because you don't know where to put a patient on a trolley," one doctor said.

Nursing staff said the were likely to lose colleagues if access block continues at the same level. "We've coped for long enough," one nurse said. "The straw to break the camel's back is out there blowing on the breeze and it will land soon. "I've had nurses that haven't been able to come to work just because they are so distressed ... they've had to take extended time off work because of work. "We're not just going to lose a nurse in the short term in ED - we are going to lose a nurse full stop ... they will never come back to a nursing role again."

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Paramedics as 'Babysitters' in hospital gridlock crisis

TAXPAYERS spend an average of $70,000 a month for off-duty paramedics to babysit critically ill patients who are unable to get a bed in gridlocked emergency departments. NSW Ambulance figures show the bill rose almost 30 per cent last financial year compared with the previous period as more patients languished in the back of ambulances lined up outside hospitals waiting for a bed. Chronic overcrowding in emergency departments has forced NSW Health to create Ambulance Response Teams, made up of off-duty paramedics paid overtime rates to sit with patients in emergency queues.

Figures obtained by The Sun-Herald show the bill rose to a record $118,218 in July and doctors say it's further proof the health system cannot cope with demand. A response team is called in when one ambulance has waited more than 60 minutes or two ambulances have waited more than 30 minutes outside an emergency department, allowing on-duty paramedics to get back on the road.

Sally McCarthy from the Australasian College for Emergency Medicine said the delays were a direct result of bed shortages. Once seen, one in four patients wait more than eight hours to get moved from emergency to a ward. Last financial year the bill for response teams was up almost 30 per cent, costing $831,769. Opposition Leader Barry O'Farrell said the money would be better spent on reducing waiting times, including through boosting doctor numbers.

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