Store-based health clinics - which are staffed mostly by nurse practitioners and offer quick services for routine conditions from colds and bladder infections to sunburn - aren't just a health care fad anymore, but fast becoming a serious industry.
About 7 percent of Americans have tried a clinic at least once, according to an estimate by the Convenient Care Association, an industry trade group formed last year. That number is expected to increase dramatically, as major pharmacy operators like Wal-Mart Stores Inc., CVS Corp., Target Corp. and Walgreens Co., partner with miniclinic providers like RediClinic and MinuteClinic to expand operations. The trade group estimated there will be more than 700 by year-end, up from the more than 400 now, and 2,000 by the end of 2008.
With the nation's $2 trillion health care system in need of repair, such an express approach to health care - which offers a wait time averaging about 15 minutes and evening and weekend hours - is being heralded as serving up a cheaper and quicker alternative than a doctor's office or an emergency room. A physical exam costs on average $60, while a flu shot typically costs about $20. A strep throat test has a price tag of about $15.
"I was frankly very impressed with how thorough (the examination) was," said Susan Anthony, who visited a clinic at a Phoenix, Md., Target for a dry cough. "And it was fast. I walked in at 10:30 a.m. and was in my car a little after 11 a.m."
The American Medical Association said a growing number of medical practices are extending their office hours or forming their own clinics to compete. But concerns about quality of care are rising among physicians and some industry experts say the clinics' services need to be more comprehensive if they are going to have a big impact on reducing overall health care costs.
The competition is already spawning expanded services as well as new spinoffs. Consumer Health Services Inc. - founded by a former investor of MinuteClinic, considered the pioneer in the industry - just started rolling out walk-in doctor's offices at Duane Reade Inc. drugstores in the New York City area. The clinics offer broader services that include wart removal and treatment for sprained ankles.
The ventures are promising enough that big-shot investors are jumping into the game. RediClinic got an undisclosed cash infusion from Revolution LLC, the investment house launched by AOL founder Steve Case.
Support among health insurance companies is also growing; about 40 percent to 50 percent of clinics accept insurance from providers like Humana Inc., UnitedHealth Group Inc. and Aetna Inc., according to CCA.
"(Store-based clinics) provide another access point for our members," said Allen Karp, the vice president of health care delivery for Aetna.
Store-based health clinics are held to the same high standards as doctors' offices, said Tine Hansen-Turten, the executive director of the Convenient Care Association. She pointed out that store clinics are either monitored by a state board of nursing or board of medicine, and sometimes by both.
The American Medical Association wants to ban the practice of health insurance companies waiving or lowering co-payments for clinic patients, which it calls a conflict of interest.
Dr. David Plocher, the senior medical officer at Blue Cross Blue Shield of Minnesota, said that "the normal market forces should determine such things." His company has reduced or waived co-payments for 25 member companies who use MinuteClinics and several other store-based clinics.
The savings can be significant.
A visit to a store-based clinic averages about $60, but a doctor's visit costs twice as much, particularly in urban markets, according to Barry Barnett, a health care consultant for PricewaterhouseCoopers. That compares to about $300 for an emergency room visit, according to Mr. Barnett.
About 40 percent to 50 percent of clinics take insurance. Ms. Hansen-Turten estimated 50 percent of clinic customers pay cash, but she noted that the majority have insurance.
Like many of his industry peers, Michael Howe, the president and CEO of MinuteClinic, said the concerns about quality are overblown.
"I wouldn't call it express care. I would call it efficient care," he said.
The AMA denies that its criticism of these clinics is being driven by economic interests, though there's no doubt that primary physicians could lose some business as their insured patients go elsewhere for minor ailments.
But health care consultants say that while the clinics may help save customers money and time, their ability to reduce overall health care costs will probably be limited given that they are really tackling the most minor of health problems.
A bigger effect lies in increased worker availability as employees don't have to take as much time out of their work schedules to go to a doctor's office, according to Dr. Tim Newman, the senior medical consultant for Watson Wyatt Worldwide.