More children expected to seek care at retail clinics

Consumer-Driven Health Care and Retail Clinics

As part of the movement toward consumer-driven health care, retail clinics (also called in-store or convenient care clinics) have developed across the country. Retail clinics advertise treatment for common acute health problems, screening tests and vaccinations that is more convenient, quicker, and less expensive than care in traditional doctor’s offices and emergency rooms. The average cost for a retail clinic visit ranges from $40-$70.

Retail clinics are small walk-in health care offices located in department stores or pharmacies, typically staffed by nurse practitioners or physician assistants. The first retail clinic opened in 2000. Today, more than twenty companies operate about 300 retail clinics in the U.S., with an estimated 2000 or more expected to open by the end of 2008.

Retail Clinics and Health Care for Children

Prior national polls have indicated that 5%-7% of Americans have used retail clinics for adult health care. No prior reports have investigated how retail clinics have been used for children’s health care, or how many families anticipate using retail clinics in the future.

In March 2007, the C.S. Mott Children’s Hospital National Poll on Children’s Health found that 10% of children and 11% of adults have used a retail clinic. Moreover, 15% of children and 19% of adults are very likely or likely to use a retail clinic in the future (Figure 1).

Current retail clinic users are more likely to use them again in the future. Among parents who had a prior visit to a retail clinic for their child, 28% are very likely and 42% are likely to use a retail clinic in the future, versus only 2% very likely and 8% likely to use a retail clinic in the future among those who had no prior use (Figure 2).

Paying for Children’s Care at Retail Clinics

A common criticism of consumer-driven health care is that it places families at greater financial risk than in more common health plans. On the other hand, proponents of retail clinics in particular argue that uninsured children and families can access health care for routine, uncomplicated problems at a lower cost than if they sought care at a standard physician’s office or emergency room. Retail clinics have reported that they are serving high proportions of uninsured patients, and have also announced that many clinics now accept insurance payment. However, these issues have not been examined regarding children.

The C.S. Mott Children’s Hospital National Poll on Children’s Health asked households how they had paid for care they had sought at retail clinics. Parents are less likely to have paid out-of-pocket for a child’s visit than are adults who have sought care themselves (Table 1). More than half of parents reported that their child’s last visit to a retail clinic was covered in full by insurance.

Parents with lower annual household income (less than $30,000) were more likely to use a retail clinic and are more likely to use them in the future than parents with higher household income.

Retail Clinics and Usual Sources of Care

In December 2006, the American Academy of Pediatrics issued a policy statement opposing the use of retail clinics as an appropriate source of medical care for infants, children and adolescents, chiefly because retail clinics do not provide a “medical home” for their patients.

This criticism raises the question of what proportion of children who have used retail clinics have a usual source of care. Overall, 96% of parents in the C.S. Mott Children’s Hospital National Poll on Children’s Health reported that their children have a usual source of care. Among children who had used a retail clinic, 89% have a usual source of care, compared with 97% of children who had not used a retail clinic.