Image: RediClinic
Beth Hall  /  AP
RediClinic health educator Thomas Wassinger helps a customer check into a clinic inside a Wal-Mart in Rogers, Ark., in this file photo. Wal-Mart has seen some in-store clinics close.
Alison
By Allison Linn Senior writer
msnbc.com
updated 8/18/2008 11:14:54 AM ET 2008-08-18T15:14:54

When Raleigh Werner first heard about clinics that offer basic health care inside pharmacies and grocery stores, his reaction was something along the lines of “Yuck.”

The 19-year-old Colby College student agrees that many in the United States need better access to health care, and he understands that such clinics could help fill that need. He just doesn’t think the solution is for people to be going to the same place they buy apples to get checked out for eczema.

After all, he argues, you wouldn’t go to the hospital to buy clothes.

“I just don’t know about mixing those two environments in the same place,” he said.

As recently as last year, Wal-Mart Stores Inc. and other retailers were touting in-store health clinics as the wave of the future, offering basic health care at low cost and with fewer hassles than a visit to your doctor’s office or the emergency room. But widespread acceptance of the clinics appears to be slow, with many consumers reporting skepticism about the idea of getting a checkup where they also get their groceries.

In addition, many in the business have been hit with operational and financial snags, forcing them to retool or even abandon their strategy.

Overall, there are about 1,000 retail health clinics currently operating in the United States, according to Merchant Medicine, an industry consulting and research group. While some clinic operators have been expanding, others have given up. In the past year, Merchant Medicine estimates that 136 clinics have closed up shop, a trend it blames in part on financiers who lost patience when the clinics weren't showing quick profits.

“I think this is a long-term process,” said Tom Charland, a former MinuteClinic executive who is now chief executive of Merchant Medicine. “The idea that within a year they’ll be profitable and people will be flocking to them is a fallacy.”

In-store health clinics, which generally operate independently within supermarkets, pharmacies or big-box retailers, are usually staffed by nurse practitioners and physician assistants, although some have doctors in the clinics. They are generally open until late in the evening and on weekends, and don’t require an appointment. Most offer basic health services, such diagnosing an ear or bladder infection or administering vaccines, for a flat fee or an insurance co-pay.

Although the clinics have been in some parts of the country for years, in many ways they are just starting to gain acceptance among insurers, employers and the general public.

“There remains an industry problem associated with broad awareness of the availability,” said Chip Phillips, president of MinuteClinic, the nation’s largest retail clinic operator. “But once you have a trial use by the consumer of this service, there is very high customer satisfaction.”

MinuteClinic, a subsidiary of CVS Caremark Corp. that operates about 500 clinics at various retail outlets, has scaled back its growth plans for the year to approximately 100 new clinics, down from an earlier estimate of 200 new clinic openings.

Wal-Mart Stores Inc., which made headlines last year when it announced plans to eventually have as many as 2,000 of the clinics in its big-box outlets, currently has just 39 of the clinics in its stores. The company has seen several operators abruptly shut down.

Christi Gallagher, a spokeswoman for the chain, said Wal-Mart is optimistic about a more recent push to partner with local health care providers, who can tout the clinics as another way to access their branded, familiar services. Despite the setbacks, she said the company remains committed to its goal of having 400 clinics in stores by 2010, and as many 2,000 by 2014.

“We see clinics as an emerging industry, and we expect to see continued changes and evolution in that space, but I can tell you that we are excited about the strong interest that we are getting from hospitals and health care systems,” she said.

Charland, the consultant, believes the in-store clinics will be part of the solution for improving health care in this country. Still, persuading the public to use them remains a challenge.

“The bottom line is that it’s difficult to, first of all, get this idea across and make people aware of where these locations are, and then finally to feel comfortable to actually get their health care in a retail store,” Charland said.

In order for an individual clinic to succeed, he thinks they must accept major insurance plans, since many people who use the clinics have insurance but want the convenience of the clinic. (Wal-Mart says about 55 percent of the people who visit its clinics are uninsured.)

Charland said the clinics also need to get support from local employers, who can encourage their staff to use them, and they must find a way promote the clinics with the retailer that is housing them.

At this point, however, there is little consistency on those fronts.

Wal-Mart, for example, only requires that the in-store health clinics offer electronic medical records, in an effort to documents patients’ medical histories should they visit another in-store clinic or want the data for their primary provider. But Gallagher said Wal-Mart does not specifically promote or market the clinics, and leaves it up to the independent providers to decide whether to do things like accept insurance.

“They’re always operating separately,” she said. “It’s just like a McDonald’s.”

There is a silver lining for retail clinic operators: Many argue that once people try the clinics, they like them.

Sharon Smolich recently took her 15-year-old son to an in-store health clinic to get treated for an ear infection. She liked that she was able go after hours, without missing work, and had no problem getting her insurance to cover the visit.

“(It’s) a nice in-between where you can actually get seen without having to wait a day or two or spending a couple of hundred dollars for an ER co-pay,” the 38-year-old Broomfield, Colo., resident said.

Phylis Golden, 59, visited a retail clinic for the first time when she needed to get a check-up for her 3-year-old grandson, who was in her care and did not have health insurance. She thought the service was thorough and the $65 fee was reasonable.

Golden, who lives in Dickinson, Texas, has since visited such clinics twice for her own minor ailments. After enduring hourslong waits to see her primary care physician, where she said she sometimes feels like little more than a head of cattle, she liked that she could see a nurse practitioner at the clinic immediately, without missing work.

“I see it as a much-needed service,” she said.

Still, many say they wouldn’t give it a try.

Diane Petty has visited other types of health clinics before, and she said that she generally doesn’t think the level of care is as good as you’ll find at a traditional doctor’s office. While companies may open such clinics with the best of intentions, she worries that the quality will suffer over time, as the clinics get busier and the staff more pressured.

Petty, who is 49, also is concerned that people will visit the clinics without telling their primary doctors, or vice versa. That could lead to dangerous drug interactions or other problems, she said.

The Nampa, Idaho, resident sees it as just one more sign of the health care woes facing this country.

“We already have so many areas where there’s, I guess you could say, a degraded level of health care,” Petty said.

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