As of August 2008, 42 operators managed almost one thousand retail clinics in the US and almost half of the clinics were located in just four states. One third of the US urban population lived within a ten-minute drive of a retail clinic. Almost all clinics provided care for minor acute illnesses, immunizations, as well as preventive health examinations or preventive screening. Some clinics also provided smoking cessation or weight loss counseling. Nearly all retail clinics offered evening and on weekend hours. Most clinics accepted private insurance and Medicare and over half also accepted some form of Medicaid. Although hospital chains and/or physician groups comprised the majority of retail clinic operators, they ran just 11% of the clinics.
To our knowledge, our study is the first systematic description of the industry in the published literature. Of the 49 articles that have been published on the retail clinic industry (English-language MEDLINE search from January 2000 through May 2009 using search terms “retail clinic” or “retail health clinic” or “retail-based clinic” or “in-store clinic”), only six are empirical studies.(4
) The focus of these six studies is the quality of care provided, the impact of retail clinics on utilization or costs, or who visits retail clinics and for what reason.
Although previous published articles described retail clinics as a nascent healthcare delivery model, (2
) retail clinics are now operating in 33 states. Further, in some cities more than 90% of the population live within close driving distance of a clinic. It is possible that the state variation in number of clinics is driven by state regulations such as nurse practitioner scope-of-practice laws or how retail clinics are licensed.(2
In prior work, the majority of retail clinic visits were shown to be for minor acute illnesses and immunizations.(4
) There has been interest in whether retail clinics will expand beyond this basic scope of care, in particular in the area of chronic disease management.(2
) We find that, to date, there has been no expansion into chronic disease management and only limited expansion into counseling services.
Physician associations have expressed concerns that the growth of retail clinics will adversely impact the coordination of care and patient-primary care provider relationships.(7
) The increasing number of hospital chains and/or physician groups that operate retail clinics might lessen these concerns, because at these clinics primary care physicians and retail clinic providers can share a common electronic record.(22
) In addition, new types of partnerships between existing providers and retail clinics have developed.(32
) Wal-Mart has partnered with local hospital chains to “co-brand” clinics within their stores (33
) and MinuteClinic and the ClevelandClinic have recently announced a partnership to run nine clinics together and to integrate their electronic medical records.(34
In the original model retail clinics did not accept insurance,(2
) but there has been a significant shift in practice. Now almost all clinics accept private and Medicare insurance and the majority accept some form of Medicaid. Evidence that retail clinics are less costly might have driven greater acceptance by these payors.(24
) To encourage more retail clinics visits, one private insurer has waived the co-payment for retail clinic visits.(35
Our analysis had several key limitations. Based on earlier retail market research, we used a five-minute driving distance to define a retail clinic catchments area. However, patients may differ from other retail consumers in the distance they are willing to travel. We looked at the entire population within a catchment area recognizing that this population is the “possible clientele” rather than the “probable clientele” of the retail clinic. A given clinic may accept one Medicaid managed care plan but not others, thus we may overestimate the number of clinics where a Medicaid enrollee could receive care. The distinction between an urgent care clinic and retail clinics is sometimes blurred and some might disagree with the inclusion of some clinics in our sample. For example, Dr Walk-In has two clinics staffed by a physician, but the clinics are located inside a drugstore and have a limited scope of care. Lastly, we created our inventory of clinics in the summer of 2008. Since that time, new clinics have opened, some clinics have closed, and two operators have gone out of business. But the overall rate of growth has slowed since that time (36
) and we believe our findings are still representative of the industry.
Continuing to monitor the location and characteristics of retail clinics over time will help providers and policymakers better understand their potential impact on healthcare.