A common assumption is that retail clinics will reduce healthcare costs, by reducing unnecessary emergency room visits. However, a March 2016 study in Health Affairs by RAND revealed a $14 increase per year in total healthcare spending per person with low-acuity conditions, whether they received care in a retail care setting or a physician’s office.
According to researchers, 58% of retail clinic visits for low-acuity conditions represented new utilization, while 42% represented substitutions for a visit to a physician office or emergency department. This suggests most consumers using retail clinics weren’t using them as an alternative to care at a costlier site. In fact, the convenience of retail care could be driving people to seek care at clinics that they might otherwise not have sought out.
The study focused on 11 low-acuity conditions—such as upper-respiratory infections, urinary tract infections, and influenza—which represent more than 62% of all visits in retail health settings. It included 519,542 patients with at least one retail clinic visit and 861,557 other enrollees chosen at random; the randomly chosen patients were selected based on similarities with patients who went to retail clinics (similar demographics such as sex, age, location, and health status). Capturing data on patient visits from 2011 to 2012, the study included patients who received coverage from insurer Aetna, which provided the data.
Researchers defined retail clinics as those located in pharmacies, grocery stores, and “big-box stores” such as Walmart and Target. The clinics primarily provide care for a limited set of low-acuity acute conditions such as urinary tract infections as well as preventive services such as immunizations.
Convenience at a cost
Ateev Mehrotta, MD, associate professor of healthcare policy and medicine at Harvard Medical School and one of the study’s researchers, says he wasn’t surprised by his team’s findings. If you make care more convenient for patients, they are more likely to access it, he says.
Emily Zuehlke, research consultant with The Advisory Board Company consulting firm, notes that while retail clinics have acted as “a pressure-relief valve for physicians’ offices,” a long-term view is important when considering how these clinics impact healthcare costs. “Some estimates show that, by preventing health risk escalation and thus downstream utilization, retail clinics can reduce total healthcare spend by a few hundred dollars per patient. Long-term savings could therefore outweigh the $14 per person cost that this study shows can result from increased retail clinic utilization to manage low-acuity conditions,” says Zuehlke, citing a 2013 study published in The American Journal of Managed Care.