Retail Clinics: Trying to Reconcile Cost Per Visit, Utilization, Access and Convenience

By Clive Riddle, March 10, 2016

The March issue of Health Affairs features a paper presenting study findings on retail clinic:  Retail Clinic Visits For Low-Acuity Conditions Increase Utilization And Spending. The title would seem to say it all regarding their findings. The study involved retail clinic use by 3 million Aetna members, from 2010 to 2012 for 11 low-acuity conditions. 

Here’s what the authors had to say in part in their abstract: “We found that 58 percent of retail clinic visits for low-acuity conditions represented new utilization and that retail clinic use was associated with a modest increase in spending, of $14 per person per year. These findings do not support the idea that retail clinics decrease health care spending.”

Kaiser Health News, in covering the story, notes that “The study doesn’t contradict earlier research that found retail clinics provide care that costs 30 to 40 percent less than similar care provided at a physician’s office and that the treatment for routine illnesses was of similar quality. But it suggests those savings are more than offset by increased use of medical services.”

But for some who embrace this perspective, but also are critics of increased consumer cost-sharing including high deductible plans that can limit access, is this perhaps a bit contradictory from a policy standpoint? If you are concerned the increased access and use of such services drives up costs, should you be concerned about cost savings measures that decrease potential access and use?

Interestingly, a Policy Brief in last month’s Health Affairs  on High Deductible Health Plans features the lead-in: “As high-deductible health plans become increasingly prevalent in both group and individual markets, it remains to be seen how they will affect health care access and outcomes.”

Is it a paradox that high-deductible health plan consumers are target audiences for retail care clinics?

Last month, NPR, Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health released the 42-page study: Patients’ Perspectives on Health Care in the United States which addressed retail clinic and urgent care use among many things. 92% of survey respondents rated retail clinic costs as reasonable, and 74% rated urgent care costs as reasonable, compared to 77% rating their personal doctor visit costs as reasonable and 58% rating emergency room costs as reasonable.

Granted, the study published in Health Affairs didn’t dispute the lower cost per visit – they just conclude that the retail supply creates demand and thus drives up costs. But what about access, and what happens to overall costs when access isn’t adequate? Isn’t that the critique of high deductible plans – that high out of pocket costs become a barrier to access?

The argument put forth in Health Affairs is your out of pocket costs might be higher per visit, but ultimately lower overall, by always sticking with your personal doctor because you will see them less.

And see them less you very well may. Another aspect of access addressed in the NPR study: 22% said they could not see their regular doctor at some point in the past two years when they needed health care, with the number one reason the doctor did not have any available appointment times (followed by care was needed at night or on the weekend.)