Retail Health Care: Redux

So what do you do if you do not have a regular health care provider and you need preventive care or care for a simple illness? According to a new study by the nonprofit RAND Corporation, you are the type of patient who would patronize a retail health clinic.

If you have missed my prior postings on the subject and have not run across the concept elsewhere, a retail health clinic is a small clinic with limited facilities that is located inside another store. Pharmacies and big box stores seem to be the usual locations they spring up in, at least so far.

At the moment, the U.S. has approximately 1,000 of these clinics, and estimations say the number will grow to a possible 6,000 by 2011. The trend is still in its comparative infancy, but like many kids, it seems to be growing fast. The RAND study is the first recorded examination of the patient demographics for this new wave of retail health care.

Via The Washington Post:

"These clinics appear to attract patients who are not routine users of the current health care system. For these patients, the convenience offered by retail clinics may be more important than the continuity provided by a personal physician," lead author Dr. Ateev Mehrotra, a professor at the University of Pittsburgh School of Medicine, said in a RAND news release.

The numbers are interesting, and bear out my predictions of earlier posts. People seem to be gravitating to this as an alternative to the perceived cost and hassle of seeing a primary care doctor. To be frank I am looking forward to seeing some of these here in New Orleans. I would certainly consider using them if they were available.

• 43% of Retail Clinic patients were in the 18 to 44 age range as opposed to to 23% of those visiting primary care physician offices.
• 39% percent of Retail Clinic patients had a primary care doctor, compared with 80% surveyed nationally.
• Retail Clinic visits paid for out-of-pocket decreased from 100 percent in 2000 to 16 percent in 2007.
• Roughly 90% of visits to retail clinics were for preventive care (medical tests) or for treatment of simple conditions or immunizations . These same conditions make up 18% of primary care visits and 12% of emergency department visits.
  

SOURCE: "Retail Clinics Attracting Those Without Regular Doctors" 09/10/08
photo courtesy of ernestl, used under its Creative Commons license

Suffer The Children, Even if They Have Insurance

A staggering new report was released this morning that puts a whole new spin on the subject of children's health care. Nine million children across the country lack health insurance. We have seen those numbers repeatedly in recent news, but are the children with coverage truly taken care of? This report's shocking findings say no, and go on to state that less than half of them are.

The Seattle Times spoke with the study's prime mover:

"I was very surprised - and very distressed - about our results," said Dr. Rita Mangione-Smith, the study's lead author and a researcher at Seattle Children's Hospital Research Institute and associate professor of pediatrics at the University of Washington School of Medicine.

"There are a lot of failures there. And on very basic things that people agree we should be doing."

The nonprofit RAND Corp. contributed to the research, which is published in the New England Journal of Medicine. It was funded by the Centers for Medicare & Medicaid Services, the Robert Wood Johnson Foundation and the California HealthCare Foundation.

The records showed that children got the proper care only 46.5 percent of the time. It relied on records collected between 1998 and 2000 of 1,536 children in urban areas who had actually seen doctors, and for whom researchers were able to obtain one or more medical records.

Experts said it is unlikely that care has improved significantly since then, except for some improvements in immunization rates and asthma care. And almost all the children in this study were insured.

While debate continues over the uninsured youth of America, this study shakes some of the perceived axioms of that discussion. It is tacitly assumed that getting all of our country's children coverage is the answer, but what then? If only half of them get proper care once insured then there seems an even longer path ahead than previously thought.

ABC News zeroed in on the demographic slant:

"We had primarily white children with insurance from middle- to upper-middle income families," said Mangione-Smith. "This is probably a best-case scenario; this is as good as it's going to get."

More than half of children studied failed to receive the care they needed. More than half in a study that had few uninsured, minority, or rural children. So basically of those children who have the best health care protection, the batting average is less than 50%. Dr. Paul Wise, a Stanford University pediatrician and health policy researcher who was not directly involved with the study, finds the results disturbing. "The quality indicators are just so awful that even if they're off by a considerable extent, they still hold up," Wise told the San Jose Mercury News. "The findings suggest that the quality of health care for children is pretty pathetic."

BusinessWeek gives us some more statistics from the report:

Some of the more startling discoveries:

• Sixty-nine percent of 3- to 6-year-olds did not have their height and weight measured at annual checkups, and only 15% of adolescents were weighed and measured, even though one-third of American children are overweight or obese.


• Fifty-four percent of children diagnosed with asthma did not get recommended treatment.


• Sixty-two percent of children were not screened for anemia in the first two years of life, although the test is recommended for all babies.


• Only 38% of children received the proper care for acute diarrhea, one of the main causes of hospitalizations in children under age 5.

As additional information is revealed, the dialogue on children's health care and insurance reform gains more and more urgency.

SOURCE: "Health Care For Kids Falling Short" 10/11/07
SOURCE: "'Stunning' Deficiencies in Kids' Health Care" 10/11/07
SOURCE: "Health Care for US Kids Falls Short" 10/11/07
photo courtesy of ninjapoodles on Flickr under the Creative Commons license