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The Boston Herald


Competition Won't Ail You

February 09, 2008

By Paul Howard

Boston's mayor has it backward: Wider access to high-quality, basic health care at an affordable price depends on the advent of profit-seeking, innovative companies like MinuteClinic.


Boston Mayor Thomas Menino is concerned about CVS's plans to locate low-cost health care clinics in retail stores in his city. Limited service medical clinics run by merchants in for-profit corporations will seriously compromise quality of care and hygiene, he has said.

He has it backward: Wider access to high-quality, basic health care at an affordable price depends on the advent of profit-seeking, innovative companies like MinuteClinic.

According to the Massachusetts Medical Society, nearly half of all internists aren't accepting new patients. For Bay Staters who are lucky enough to have a doctor, the average wait for an appointment is now over seven weeks. As the state moves hundreds of thousands of the uninsured into the health care system, retail clinics can reduce demand on overburdened providers.

The reason for the unavailability of primary care is the variety of disincentives to providing it, including low or declining reimbursements from Medicare and other insurers combined with rising costs. Fed up with doctor's unavailability, many patients are crowding into expensive emergency rooms for treatment of routine ailments.

The convenient-care clinic model arose from the mismatch between what consumers need and what the health care system was offering them. QuickMedx, MinuteClinic's predecessor, got its start in 2000 when founder Rick Krieger tried, and failed, to get his son into a doctor's office for a quick step test. He wondered why there wasn't a way to get care, in a relatively timely manner for a relatively simple illness.

Krieger sensed a market and set up clinics in a local grocery chain, charging a flat $35 for almost a dozen easy-to-treat conditions. Since then, the retail clinics have blossomed nationwide, with hundreds opening at competing retailers such as Walgreens, CVS and Wal-Mart.

What about the qty of care? In 2006 MinuteClinic received from Minnesota Community Measurement—a nonprofit collaborative of doctors, health plans and employers that rates clinics and doctors across the state—its highest score (99 percent) for treating children who were diagnosed with sore throats. MinuteClinic even beat out the prestigious Mayo Clinic. Wal-Mart reports that more than 90 percent of consumers surveyed were satisfied or very satisfied with its clinics.

The prescription for the clinics' success: Strict protocols to ensure high-quality care, low prices that are clearly posted and convenience. An-other bonus: Approximately 55 percent of customers who seek care at Wal-Mart's clinics are uninsured, with 10 percent to 15 percent reporting that they would have otherwise used the emergency room.

The surge in convenient care clinics represents what Harvard Business School professor Clayton Christen¬¨sen calk "disruptive innovation"—substituting a low-cost product or service for a higher-cost one. Rather than rail against the clinics for what they don't offer, policymakers need to find ways to spur disruptive innovations like MinuteClinics.

Here are three ways to enlist profit-making in the service of improving America's health care system:

— First, insurance coverage should be redesigned around individuals, not employment Employer-based coverage (which is tax-free) is unfair, because those who don't receive it have to buy health insurance with after-tax dollars. Giving the deduction directly to individuals would encourage them to shop for plans that paid for convenient-care clinics, wellness and prevention programs, or even medical tourism.

— Next, Congress should allow consumers to buy health insurance across state lines. The Council for Affordable Health Insurance estimates that state regulations can add as much as 45 percent to costs.

— Finally, the private sector and policymakers should keep pushing to collect and publish information on health care pricing and quality, so that consumers can make informed comparisons among providers.

Retail clinics show how the lure of profits creates opportunities for competition and quality care at an affordable price. In a world where consumers are able to control more of their own routine health-care spending, more companies will have an incentive to become disruptive innovators, healing the sick and helping themselves at the same time.



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