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Posted: 6:00 a.m. Tuesday, April 22, 2014

Easy Way To Save Money on Health Care

Pharmacy chains to roll out more nurse-in-a-box clinics

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By Clark Howard

ClarkHoward.com


Your access to health care is getting easier in America today.

I've talked in the past about "nurse-in-a-box clinics" at retail storefronts that offer care 7 days a week from nurse practitioners.

BusinessWeek reports 16 of 50 states allow nurse practitioners to practice as primary care providers without restrictions. In the remaining states, the local affiliates of the American Medical Association have supported anti-competitive laws that restrict nurse practitioners. But there's a strong movement in those states too to give pushback.

This is one genie you can't put back in the bottle. According to one new estimate I saw, there will be 3,000 nurse-in-a-box clinics throughout the country by the end of next year.

What kind of care can you get?

I can't speak to the quality of clinincal care offered by nurse practitioners because I'm just an average guy with no training or knowledge. But a study by the Rand Corporation found zero evidence that they provide lesser care. The authors of another study were so impressed by nurse practitioners that they wanted to end the anti-competitive laws in a majority of states to better provide care for people.

The first law of being a doctor is do no harm. But these laws do harm. If you're a physician and you think I'm wrong, go to Clark Stinks and tell me.

Meanwhile, some of the big pharmacy chains are looking to expand the number of nurse-in-a-box clinics they have on the ground. CVS is expanding from 600 clinics to 1,000 across the country. Walgreens plan to expand too.

A few years ago, everybody wanted in to this market space, but nobody knew the business model. So you had Wal-Mart boasting they'd have 2,000 clinics, but they fell flat on their face and haven't figured out the business model yet. Ditto for Kroger too.

But the clinics are a natural outgrowth for the big pharmacy chains. So many people who don't have a primary doctor come to their pharmacists looking for advice, essentially putting them in the difficult spot of being asked to practice medicine.

The nurse-in-a-boxes are a key solution to that problem, because in medical school, nobody wants to be a general practitioner, or a family practitioner, or a pediatrician. (All the income potential is in the specialties.) We need an alternate way to provide that care. And nurse practitioners are the unsung heroes of making it affordable in America.

Assessing the cost of care

A few year ago, the Annals of Internal Medicine published a study that examined the cost and quality of care people who had 3 common illnesses — otitis media (middle ear-infection), pharyngitis (sore throat), and urinary tract infection — received at a doctor's office, at an urgent care center, and in an emergency room at a hospital.

The study was done by a team of PhDs and MDs from the University of Pittsburgh working in conjunction with two health-related research foundations, and the results didn't surprise me.

"Overall costs of care for episodes initiated at retail clinics were substantially lower than those of matched episodes initiated at physician offices, urgent care centers and emergency departments. ($110 vs. $166, $156, and $570, respectively)," the journal reports.

And then there's this conclusion statement from the study's authors: "Retail clinics provide less costly treatment than physician offices or urgent care centers for three common illnesses, with no apparent adverse effect on quality of care or delivery of preventive care."

That last phrase — "with no apparent adverse effect on quality of care or delivery of preventive care" — tells me everything I need to know!

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