August 13, 2008
Union Leader
Sometimes good things happen without the government being involved in any way. It doesn’t seem possible, but health care is one of those areas where reform is happening even though no central planner has passed on his administrative wisdom.
We usually want government to do something to fix a problem or stop doing something that we think isn’t fixing a problem. The most faithful readers of this column will note that despite my anti-government proclivities, I am usually carping about some government action or another. I wish it would do more of this or less of that.
In health care, change is coming not from the admirable actions of one state exported to 49 others but from real people trying to solve real problems without the government getting involved.
Convenient care clinics are springing up around the country, creating greater convenience and more service and lowering costs. Well-established in some parts of the country, this approach is only just now coming to New England.
We’re used to going to a doctor’s office for everything big and small. We make an appointment whether for a routine vaccination, to renew a prescription or because we think we’re getting pneumonia.
But not every ailment needs a doctor’s visit. Convenient care clinics are walk-in retail clinics that provide non-emergency care in convenient locations. Many of the first clinics were located in large stores, such as Target or in drug store chains. They are usually open seven days a week and on many evenings, hence the name “convenient care.”
A convenient care clinic will post a price list in the waiting room so you know exactly what each procedure or visit costs. This much for a flu shot; this much for ear wax removal. For most of us, we have no idea what a doctor’s visit costs. We know what our co-pay is, but does your insurance get charged less for some things than others?
While some clinics are staffed by a doctor, many are staffed by nurse practitioners. Most doctors’ offices use nurse practitioners interchangeably with doctors for the vast majority of visits. It helps them see more patients more quickly.
Nurse practitioners are a critical component as the country — and New Hampshire in particular — faces a shortage of primary care doctors. A nurse practitioner has an advanced degree, prescribes, diagnoses and is interchangeable with a doctor in many practices for the majority of procedures and illnesses in primary care.
The convenient retail clinic is designed not to supplant traditional primary care but to supplement it and fill a need. Each clinic has a scope of practice, 30 or 40 basic things it treats, and makes referrals to typical primary care physicians. The costs are usually 25-30 percent less than a typical primary care doctor’s office because they’re specialized.
In Minnesota, where clinics have become commonplace, insurance plans have started to eliminate co-pays for clinic care because their costs for basic services are so much less.
Clinics are expanding across the country. They are expected to grow from about 800 clinics at the end of 2007 to 1,500 by the end of this year. So far, the only New England state with convenient care clinics is Connecticut, but we can hope they come to New Hampshire soon.
Convenient care clinics are one way to slow rising health care costs without sacrificing care and by offering greater service to consumers.
Urgent and emergency care is experiencing an availability crisis similar to that in primary care. From 1995-2005, the number of emergency rooms declined by 10 percent even though the number of emergency room visits increased by 20 percent to 115 million.
The Wall Street Journal reported last week that this crisis has led to growth in another type of retail clinic, urgent-care walk-in clinics. The clinics aren’t designed for the most serious cases like chest pains but are a great solution for things like broken bones.
According to the Centers for Disease Control and Prevention, 35 percent of emergency room visits were semi-urgent or non-urgent, meaning they could wait for an hour or more in an emergency room while doctors treated the more urgent cases. More than 8,000 urgent care clinics around the country can reduce the strain on the 3,800 emergency rooms we have left.
Two significant changes are helping our health care system and no one in the government had to plan them.
Charles M. Arlinghaus is president of the Josiah Bartlett Center for Public Policy, a free-market think tank in Concord.