Every fall, another somber seasonal marker arrives: the flu. The CDC estimated that in the winter of 201819, about 42 million people got sick from the flu, causing 647,000 hospitalizations and 61,000 deaths. These numbers would be lower if more adults heeded medical advice to obtain a flu shot, yet only about one-third of prime-aged adults do so.

Enter the retail clinic. Retail clinics arrived on the healthcare scene in the early 2000s as a convenient and affordable alternative to doctors offices, urgent care centers, and emergency rooms (ERs). Because they are usually in big box stores or pharmacies such as Walmart and CVS, retail clinics are conveniently located. And because they serve customers on a walk-in basis, they are convenient to access. Their services include basic primary care for minor illnesses and injuries, such as sore throats, bug bites, and minor burns as well as preventive primary care, such as vaccines and diabetes glucose monitoring.

Providing these medical servicesat convenient times and locationsmay affect how many people end up in the ER for minor conditions. A recent study found that the prices in retail clinics are around 80% lower than ER prices for the same service. Retail clinics thus have the potential to not only expand medical services but to do so while saving money. But do they live up to this potential?

This question animates a recent research article by Diane Alexander, economist, Federal Reserve Bank of Chicago; Janet Currie, Henry Putnam Professor of Economics and Public Affairs, Princeton University; and Molly Schnell, assistant professor of economics, Northwestern University. Economics writer Lisa Camner McKay summarizes their research.

While ideally researchers assess how a populations health changes when a retail clinic opens, such extensive health data is difficult to assemble. To gain traction on the impact of retail clinics, then, Alexander, Currie, and Schnell analyzed how the numbers of ER visits for different categories of illness are affected by the presence of retail clinics in the state of New Jersey.

They found that people who live within two miles of a retail clinic after it opens do indeed have fewer visits to the ER for the minor illnesses and injuries that retail clinics treat than do people who live farther away. Retail clinics also reduce ER visits for illnesses that can be prevented via appropriate primary caremost notably, visits for the flu decline by 13%. This suggests that retail clinics, with their low, transparent prices and convenient hours, make an important contribution to the healthcare landscape.

A theory of retail clinic usage

Before diving into the data, Alexander, Currie, and Schnell developed a theory as to how the presence of retail clinics affects the healthcare setting in which patients receive treatment. This theory provides concrete predictions that they then test with data. The authors assumed that patients select a venue based on the severity of their condition and the cost of the treatment, making retail clinics best suited for low-severity conditions, doctors offices best suited for mid-severity conditions, and ERs best suited for high-severity conditions. The arrival of a retail clinic, then, will affect how many people visit the ER via two mechanisms: substitution and prevention.

First, the authors theorize that patients with low-severity, treatable conditions will substitute the ER for a retail clinic when a retail clinic is convenient. These conditions include minor illnesses and injuries that can be treated by a nurse practitioner or general medical practitioner, such as ear infections, eye infections, upper respiratory tract infections, sore throats, urinary tract infections, sprains, and strains. The authors call this class of condition primary care treatable.

Because these conditions require treatment relatively quickly, these patients may end up in the ER if they cant get a doctors appointment. If a retail clinic opens nearby, however, some of these patients should switch to the clinic because of its convenience and low cost. In particular, patients with the least-severe conditions in these categories should be more likely to switch venues, leaving the ER to handle fewer but more severe visits in the primary care treatable category.

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Second, the authors theorize that ER visits will be prevented when a retail clinic opens because more people will receive preventive primary care. In this class of conditions, dubbed emergent, preventable, the authors focus on influenza and diabetes. These are illnesses that can be avoided or controlled in an outpatient setting if they are treated properly (with flu shots and glucose monitoring), but if they go untreated, they will land some patients in the ER.

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Retail Clinics Make Important Contribution to Healthcare - Managed Healthcare Executive