

Study Gives High Marks To Retailers' Clinics - FleursDuMal
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/14/AR2009091402162.html

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motoko
I know the primary care outpatient business, and I support "Walmart medical
care." (We call them "counter clinics.")

People who don't want expert medical advice go to the counter clinic, we don't
have to serve resentful patients, and we can spend our time thinking about
medicine with patients who appreciate our service.

Further, patients sometimes visit a counter clinic, but they have issues
beyond what the counter clinic can handle. So, the counter clinic will refer
the patient to us ---the medical doctors. One of our most regular patient
referrals is corner CVS because the local medical doctors introduced
themselves respectfully to the CVS clinic staff.

However, don't be fooled by the "cost cutting" nonsense. My estimation is that
counter clinics increase total medical spending in the same way that shopping
at Wal-Mart increases total consumer spending. Yes, each individual purchase
of "health care" is moderately cheaper. However, given the lower prices,
omnipresent availability, and cross-marketing of other products in the store,
people do not simply buy the same things at a lower cost, they impulsively buy
many smaller purchases of dubious value.

So, rather than visit an outpatient medical doctor for an hour for $500 (that
is what we bill, though we usually only collect about $300 of that from
insurance), one visits the Wal-Mart counter clinic for $70. That's a savings
of $430, right? Maybe. Assume the counter clinic treated your sore throat, but
you also had another issue, and later visited the medical doctor. Both issues
could have been treated by the medical doctor for $500 now rather than $570
over several weeks. Oh, and you also bought "health supplements." Add another
$30 recurring cost. Well, actually, you don't go to the doctor at all because
you only have $500 for health care, and the doctor costs $500, but you only
have $400 because you've already spend $100 on the counter clinic and
supplements ---oops, actually, that $400 is already spent by your employer for
health insurance.

So, you still pay, but you never visit a doctor, chronic heath conditions
continue to exasperate, and in addition to suffering from chronic health
problems, you eventually get very sick, progressively lose your ability to
function, and are hospitalized sooner at a much higher cost.

Even a single day of missed work at $5 minimum wage due to illness not
addressed by a counter clinic is quantitatively worth more than the $37 best
case savings at the counter clinic. Primary and preventative care alternatives
are almost never "cost savings" unless you know precisely otherwise.

By the way: there is some ludicrous cultural myth that exasperated health
problems can be "fixed," or if you can just avoid "having a a serious problem"
and "keep natural," you will be OK ---or at least, you can "fix" health
"issues" "later."

No, you don't. You die.

Also, jeez, you spend so much time and money making your face and buying
clothes, but when you have a disease, you're thinking about saving a few dozen
dollars? Bleh.

~~~
catzaa
The problem is that doctors charge ridiculous amounts even for simple
treatments. If I have Bronchitis I know exactly what I need and the doctor
knows it too. Yet he will charge a shitload for a 10 minute appointment.

The same with medical tests – the doctors draw blood and send it to a
pathologist. They then charge you a 400% mark-up on that and make pure profit.
Then it is the unnecessary x-rays (if the doctor happens to have a digital
x-ray machine that he is itching to use).

If a doctor prescribes anything he will prescribe the most expensive
antibiotics ever – even though a much cheaper run of the mill one will work as
well (I don’t know why they do that).

Why do they want routine appointments (once a month) for chronic medicines?

No offence, but I think modern day doctors focus on ripping off medical
schemes because there is no apparent victim.

~~~
motoko
> The problem is that doctors charge ridiculous amounts even for simple
> treatments.

Assuming you are a programmer, why should I pay to use your software? I would
prefer to pay nothing because it doesn't "cost anything" to copy it. Oh, well,
ok, I'll pay for my 10 minute share of your time at $40 / hour. You have to
eat, too.

> If I have Bronchitis I know exactly what I need and the doctor knows it too.

Great. Go visit a counter clinic and get exactly what you need ---though I'm
sure you know that you have acute viral bronchitis and you only needs some
over-the-counter drugs to treat symptoms. Then, you can go reinvest your
"shitload" in something more intelligent like car insurance or a new graphics
card. Like, your lungs are fine. I'm pretty sure all lungs have been fine
forever for everybody, and if not, well, you can buy a new lung from the lung
store and swap it in for all those shitloads you saved in ten minutes years
ago. It will probably even be a better lung than your old obsolete one.

"The same with medical tests – the doctors draw blood and send it to a
pathologist. They then charge you a 400% mark-up on that and make pure
profit."

You're right. Health care should be like sex. Free only, illegal otherwise,
immoral regardless. There should be laws to enforce this.

"Then it is the unnecessary x-rays (if the doctor happens to have a digital
x-ray machine that he is itching to use)."

Say no.

"If a doctor prescribes anything he will prescribe the most expensive
antibiotics ever – even though a much cheaper run of the mill one will work as
well (I don’t know why they do that)."

Did you ask?

Also, doctors prescribe generally prescribe what will be most likely to work
the fastest because ---if you remember from a century ago--- bacterial
infections kill you and then spread to your friends and family to kill them.
They don't care that you can save $30 with some similar drug they don't know
much about.

"Why do they want routine appointments (once a month) for chronic medicines?"

Because

"No offence, but I think modern day doctors focus on ripping off medical
schemes because there is no apparent victim."

If you know some rip off scheme perpetuated by licensed medical doctors, write
it down and submit it to a medical journal. I think modern day people focus on
engorging distractions while they mindlessly spawn and decay because there is
no apparent victim. No offense.

~~~
catzaa
> Go visit a counter clinic and get exactly what you need ---though I'm sure
> you know that you have acute viral bronchitis and you only needs some over-
> the-counter drugs to treat symptoms. Then, you can go reinvest your
> "shitload" in something more intelligent like car insurance or a new
> graphics card.

The problem is that in my country you cannot get a prescription without a
doctor’s appointment. What happens (at least with me) is that I wait to see if
I get better by myself.

> You're right. Health care should be like sex. Free only, illegal otherwise,
> immoral regardless. There should be laws to enforce this.

Nowhere did I claim that. What I meant was that doctors have a conflict of
interest. On the one hand they should care for your health and on the other
hand they should make as much money as possible. That causes a lot of doctors
to prescribe unnecessary tests and perform unnecessary x-rays. In my country
there was a law that allowed doctors to sell medicine (usually a pharmacy had
to be owned by a pharmacist). This caused a lot of doctors to give out overly
expensive medicine that people do not need.

> Say no.

And the doctor will tell you that _it is really necessary_. Since most people
do not know the field they will believe the doctor with blind trust.

> Also, doctors prescribe generally prescribe what will be most likely to work
> the fastest because ---if you remember from a century ago--- bacterial
> infections kill you and then spread to your friends and family to kill them.

They actually do that to make money (see above).

> They don't care that you can save $30 with some similar drug they don't know
> much about.

Those “similar drugs” are run of the mill anti-biotics that have been on the
market for 20+ years.

~~~
motoko
"The problem is that in my country you cannot get a prescription without a
doctor’s appointment."

Acute viral bronchitis: [http://www.amazon.com/s/ref=nb_ss_0_9?url=search-
alias%3Dhpc...](http://www.amazon.com/s/ref=nb_ss_0_9?url=search-
alias%3Dhpc&field-keywords=cold+medicine&x=0&y=0&sprefix=cold+medi)

"They actually do that to make money (see above)."

In the USA, doctors do not make money from drugs directly, though they may
indirectly benefit from pharmaceutical "good-will." However, that's more
common for new drugs that patients would take chronically, like psych drugs,
not antibiotics to treat common, acute issues.

"And the doctor will tell you that it is really necessary. Since most people
do not know the field they will believe the doctor with blind trust."

Well, do you really know the field enough to know that it's _not_ necessary?
And if so, then why would this be relevant to you?

"Those “similar drugs” are run of the mill anti-biotics that have been on the
market for 20+ years."

The standard of care evolves ---as do the "biotics."

------
baran
This is the healthcare of the future.

The basic care that you receive will come from a physician assistant/nurse
practitioner. This dramatically cuts down on cost while mantaining an adequate
level of care. Physicians are going to continue to become more and more
specialized. Which leads to physicians only providing specialized/unique
treatments.

~~~
Dove
I agree. This is a sign that health care is in the process of fixing itself.

If you have 45 minutes to kill, you can listen here
(<http://dpcare.org/wa_health_underwriters>) to a Seattle doctor talk about
the issues, his company's approach, and why direct primary care is such a good
thing. He advocates concierge care as opposed to the Walmart care discussed in
the article, and I find the approach to be more sound. His approach is like
Performace Based Logistics for medicine--the doctor that keeps you healthier
makes more money, and I like that incentive. Nonetheless, both his solution
and the Walmart solution are attempts at taking advantage of the same idea:
paying directly for primary care can both lower costs and improve quality
because the time and money required to pay for routine things with insurance
is so terribly high.

I am convinced we are witnessing the birth of a revolution in medical care. I
pay out of pocket for primary care, _even though my insurance would cover
everything if I went to a traditional provider_. The new way is that much
better than the old way -- and that cheap.

~~~
litewulf
(If the doctor that keeps you healthier makes you more money, will that not
drive doctors to less risky specializations? I'd imagine that a brain surgeon
for example sees many more people who are likely to die than say a
dermatologist.)

~~~
billswift
There was a study a long while back, I think I read it in the mid 90s, that
the best doctors and hospitals had lower recovery rates, because they took the
worst, most difficult, cases. I saw it as part of a discussion of the
difficulty of rating health care service providers.

------
dspeyer
It's worth noting that all the pro-retail-clinic claims in this article come
from a study done by the RAND Corporation. This is not an entity known for
single-minded pursuit of truth. It is closely (though informally) tied to the
republican party.

------
_ck_
Given the trend and lack of care about suffering in this country, in a decade
all we'll be able to afford is health care "vending machines".

Instead of talking to people, you'll stick your arm in one machine socket and
spit into another and it will take your blood and analyze your fluids for the
flu, a dozen diseases and genetic defects. Then it will print out a
prescription with a credit for the store it's located in.

You'll be force-fed advertising while the process happens and then they will
sell the results to various other corporations which will then market you
cures. They'll be able to do this because they will flash an EULA on the
screen waving all your rights, which you have to agree to so you can get help.

Then the medical vending machine corporations will have a massive lobby for
their rights in Congress which cannot be defeated because they will get the
loons on their side to defend their massive profits as "American Values".

