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Health Care in a Big Box

Medical clinics are opening in stores like Target all over the country. Are these one-stop shops a boon or bane to the health care industry?

By Martin Downs
WebMD Feature

Reviewed By Brunilda Nazario

Discount superstores, or big-box stores as many like to call them, epitomize the wants of time- and budget-strapped American consumers: everything, cheap, in one place. For shoppers in greater Minneapolis and Baltimore, that includes not only housewares, groceries, and photo processing, but also health care.

At Target stores in these cities you can get medical tests, vaccinations, and treatment for minor ailments at a MinuteClinic, located near the store pharmacy. A menu posted outside the clinic lists the services available and conditions treated, with a price for each. Sinus infection, $44. Mono, $51. Cholesterol test, $37.

Patients need no appointment, and a visit is supposed to take about 15 minutes.

"If there are two or three people ahead of them they can take a beeper and do some shopping, and we can beep them, or they can leave their cell phone number," says Cathy Wisner, PhD, a nurse practitioner who works at a Minneapolis MinuteClinic and is also a company vice president.

You won't see a doctor at a MinuteClinic. There are none. Nurse practitioners, qualified and licensed to provide the kind of care MinuteClinic offers, do the job, aided by a computer program that guides them through the process. If a patient comes in with what he thinks is strep throat, for example, and the strep test comes back positive, the program will let the practitioner print out a prescription for antibiotics. If it's not strep, then the software won't allow antibiotics to be prescribed.

Patients whose problems turn out to be more serious are referred to their primary care doctor or an emergency room, in which case there's no charge for the visit. MinuteClinic CEO Linda Hall Whitman likens the MinuteClinic model to self-serve banking. "You wouldn't go to MinuteClinic for appendicitis or chest pain, and you wouldn't go to an ATM to take out a mortgage," she says.

If nothing else, MinuteClinic shows that people don't mind getting medical attention at the same place where they buy their laundry detergent. Since the first one opened in 2000 (under the name QuickMedx) at a Minneapolis Cub Foods supermarket, MinuteClinics have treated more than 130,000 people.

"I think there is a need in many areas of our country for that kind of care," says Judy Hendricks, a nurse practitioner in Delaware and board president of the American College of Nurse Practitioners. "If there's adequate screening and referral processes, then it's a service to the community."

The location of MinuteClinics in big-box stores highlights how central those stores are to life in many parts of America, but it doesn't appear to be a move by retailers to capture a bigger share of the health care market. MinuteClinic's business relationship with stores in which it operates may be symbiotic, but it's limited to leased space.

In addition to its Target and Cub Food locations, there are MinuteClinics on the University of Minnesota campus and at the Best Buy and Guidant corporate headquarters.

Saving Time and Money?

"It's all about time," Whitman says. "People are just out of time."

Considering that a MinuteClinic visit could be accomplished during a lunch break, whereas a trip to the doctor could take most of the afternoon, the appeal is obvious. Relatively low cost is a draw, too.

According to the Minnesota Council of Health Plans, an industry association, the average charge for seeing a doctor about a sore throat, including a strep test, is $109. A visit to a hospital emergency room for the same thing averages $328. MinuteClinic charges $48.

Most insurance plans in the areas MinuteClinic serves cover the visits, and patients are charged the same co-payment as for a traditional doctor's office visit. Some companies that provide their own health insurance, typically larger corporations, encourage workers to use MinuteClinics. "We have great support by self-insured employers," Whitman says. "In Minnesota, 23 employers have chosen to eliminate or discount the co-pay."

But not everyone sees the MinuteClinic model as an ideal fix for an overburdened health care system.

"It definitely disrupts the doctor-patient relationship," says Mary Frank, MD, president of the American Academy of Family Physicians. "It isolates problems that sometimes can be openings to other health care issues, or preventive-care discussions."

Whitman, however, argues that MinuteClinic keeps primary care providers in the loop. The software that practitioners use automatically faxes a copy of a patient's diagnostic record to the primary care doctor.