Implications for Patients
Some people with no insurance coverage just won’t get healthcare until they are in extremis—a costly choice for the patient’s well being and longevity, as well as for the entire health system.
More recently, alternative care choices have popped up that may meet the short-term needs of this population. In some Hispanic areas, “medical” clinics that operate on a cash basis have cropped up in garages and homes. The very nature of these clinics has placed them outside of traditional regulatory scrutiny, putting this fragile population further in jeopardy.
In the true tradition of American enterprise, new “minute clinics” are starting to show up in supermarkets (e.g., ShopRite, Piggly Wiggly, Wal-Mart) and in pharmacies (e.g., Rite Aid, Walgreens, Duane Reade). In these locations—for a set fee of about $39-$49 per visit—patients can get quick, straightforward care where they shop, usually from a physician assistant or a nurse practitioner, with physician supervision offsite. Estimates are that there are currently more than 150 such retailed-based health clinics, treating non-urgent health conditions, around the country today. And with demand high, it is expected that these will continue to blossom.
Implications for Primary Care and the Health System
Will these minute clinics become the treatment choice for the cash patient? Will they encroach on traditional primary care? Will an ever-increasing part of the population see healthcare in bursts, in snapshots of care provided in shopping malls, or—for the acutely ill—in emergency departments and subsequently in hospitals? When so much is known about the economies of preventive care—not to mention the value in reducing morbidity and mortality for the individual—and with the predictive value of the genome on the horizon, does the trend to push so many people out of the traditional system, simply because of lack of funding, make sense to anyone?
Implications for Business and America’s Future
Businesses are caught in a bind. They do not have the revenue to absorb double-digit increases in insurance premiums. They are faced with the difficult choice of either reducing benefits to their workers or reducing their work force. By reducing or eliminating health insurance benefits, however, they potentially damage the very workforce they need to keep healthy—and not distracted by the health of their families—in order to be competitive in a global market.
American businesses have shouldered the burden of paying for healthcare in many ways. They pay directly for employee health benefits and workers’ compensation. By paying taxes, they fund Medicare and Medicaid. Many businesses shoulder additional burdens from previous union contracts for benefits for retired employees. All of this comes about in a global market in which many of their foreign competitors cover a much smaller portion of their countries’ health bills.
In the end, I am convinced that hospitalists and all hospital professionals, along with many other physicians, will step into the breach and provide the best healthcare quality they can, regardless of the patient’s ability to pay for the care. That is just what we do. But the time has come for those of us who think and act on the nation’s health problems, who should have a longer term and more global view, to step out and step up to change a system that is currently leaving almost 50 million Americans on the side of the road.
I simply ask the question, “If not us, who?” TH
Dr. Wellikson has been CEO of SHM since 2000.