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Baltimore Examiner


Health care innovation, and its enemies

February 07, 2008

By David Gratzer

In Boston, people can walk into a store and buy tobacco and alcohol. They can also purchase sugary soft drinks, high-fat foods and herbal medicines of dubious clinical use. If Mayor Thomas Menino gets his way, however, they will be unable to see a licensed health professional for a flu shot because it "jeopardizes patient safety."

Vice, junk food and snake oils are OK, but the mayor has started a campaign to ban retailer-based walk-in clinics, reasoning that "allowing retailers to make money off of sick people is wrong." The problem for American health care is that while Mr. Menino's position is exceptional—he is as yet the only mayor to oppose these clinics—his sentiment has influenced health care laws and regulations for decades, leaving us with fewer options and higher costs.

Across America, walk-in clinics are appearing in stores like Wal-Mart and Walgreens. Staffed by nurse practitioners and other trained clinicians, RediClinic, MinuteClinic and other chains offer basic health services—and low prices. Flu shots, vaccinations and strep tests are all available. Fees are posted, appointments aren�t required, the hours are convenient. Shoppers can literally walk in and out in minutes, armed with a prescription. And to ensure continuity of care, many now give each patient a clinical note to take back to his or her family doctor. And for those without? At the MinuteClinic, it provides a list of local physicians.

The concept is hardly new. Large companies have offered employees such clinics for years. On a recent visit to Pitney Bowes' head office, the medical director showed me the company's in-house clinic, which serves everyone from the mailroom clerks to the chief executive officer. For those of us not working in a Fortune 500 company, the Wal-Mart walk-ins and their rivals offer the same sort of alternative to time-intensive doctors' office visits and ever-expensive emergency rooms.

All things considered, it's a win-win: People have another health care option, and ERs will be less taxed. But opposition has been strong. My colleagues have been particularly vocal. At last year's American Medical Association annual meeting, delegates declared war, claiming that the walk-in clinics were unsafe. They demanded national guidelines and state investigations into clinic operations.

Opposition from physicians groups kept MinuteClinic out of Rhode Island for a decade and slowed growth in other states, including Georgia. In the Bay State, the Massachusetts Medical Association protested, as did professional associations representing family physicians, hospitals, community health centers and pediatricians. Angry docs have found a partnership with politicians—like the Boston mayor—who are skeptical of markets.

The irony is that in places like Boston, the clinics would be successful because of the crisis in primary care—created by government meddling. Physician reimbursement is relatively low in Massachusetts for Medicaid and publicly subsidized insurance (Commonwealth Care). As a result, many docs aren't interested in primary care; those who have hung a shingle are feverishly busy. According to the Massachusetts Medical Society, half of internists aren't accepting new patients.

Northeastern University professor Hortensia Amaro, a member of Boston's Public Health Commission, supported walk-in clinics opening in that city. Her reasoning wasn't exactly an unabashed defense of free-market principles; rather, as she told the Boston Globe: "It's almost impossible to get a primary-care doctor in Boston. I've waited nine months to get an appointment, and I have great insurance."

The war over the walk-ins is all too common in health care, where paternalistic politicians team up with vested interests. Of course, Baltimore is not Boston. These clinics have been here for the past few years. But Maryland and Massachusetts are not dissimilar: Both states heavily regulate health insurance, for example. A health insurance policy in Baltimore will cost roughly 30 percent more than one in Columbus, Ohio. Unfortunately, this example is not isolated in health policy, where for 60 years we've regulated first and asked questions later, affecting the price of everything from health insurance to prescription drugs.

For the record, I've never gone to a walk-in clinic. This fall, I got my flu shot, not past aisle 7 at the Wal-Mart, but from a family doctor in her office. Maybe it's my physician bias. But that was my choice, as it should be.

Original Source:



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