Sociodemographic Characteristics of Communities Served by Retail Clinics
Sociodemographic Characteristics of Communities Served by Retail Clinics
Purpose: As a rapidly growing new health care delivery model in the United States, retail clinics have been the subject of much debate and controversy. Located physically within a retail store, retail clinics provide simple acute and preventive services for a fixed price and without an appointment. Some hope that retail clinics can be a new safety-net provider for the poor and those without a primary care physician. To better understand the potential for retail clinics to achieve this goal, we describe the sociodemographic characteristics of the communities in which they operate.
Methods: We created an inventory of all retail clinics in the United States and determined the proportion that are in a health professional shortage area (HPSA). We defined each retail clinic's catchment area as all census blocks that were less than a 5-minute driving distance from the clinic. We compared the sociodemographic characteristics of the population within and outside of these retail clinic catchment areas.
Results: Of the 982 clinics in 32 states, 88.4% were in an urban area and 12.5% were in an HPSA (20.9% of the US population lives within an HPSA). Compared with the rest of the urban population, the population living within a retail clinic catchment area has a higher median household income ($52,849 vs $46,080), is better educated (32.6% vs 24.9% with a college degree), and is as likely to be uninsured (17.7% vs 17.0%). In a multivariate model, the census block's median household income had the strongest association with whether the census block was in a retail clinic catchment area (odds ratio, 3.63; 95% CI, 3.26–4.05; median income, ≥$54,779 vs <$30,781, respectively).
Conclusions: We found that relatively few retail clinics are located in HPSAs and that, compared with the rest of the urban population, the population living in close proximity to a retail clinic has a higher income.
Offering a novel method of health care delivery, retail clinics have garnered significant interest from patients, politicians, physicians, and health plans. They are called retail clinics because they are physically located in retail stores like grocery stores, drugstores, or "big box" stores such as Wal-Mart. Retail clinics provide walk-in care for a limited number of acute illnesses and preventative care services for a fixed price. Visits are usually covered by most health insurance plans. Generally staffed by nurse practitioners, retail clinics focus on patient convenience by requiring no appointment and offering night and weekend hours. The number of retail clinics has increased rapidly, and it is estimated that there were 3 million patient visits to retail clinics in 2008.
As the number of retail clinics has increased, several physician associations have raised concerns about the retail clinic model. They worry that retail clinics can possibly increase fragmentation of care, provide inferior care, and adversely impact the delivery of preventative care. Most retail clinics are owned by for-profit drugstore chains. Some have worried that, in an effort to increase pharmacy sales, retail clinic providers will overprescribe medications. However, policymakers, including California Governor Arnold Schwarzenegger, Pennsylvania Governor Ed Rendell, and Senator John McCain, have supported the growth of retail clinics and included them in their health reform proposals. Potential cited benefits of clinics include improving access to care and providing affordable care for the poor and underserved.
Despite the interest and controversy generated by retail clinics, there has been little empirical evaluation of their impact. The goals of this study were to describe the location of retail clinics, determine whether they are disproportionately located in areas with a scarcity of health providers, and describe the sociodemographic characteristics of the population that lives close to a retail clinic.
Abstract and Introduction
Abstract
Purpose: As a rapidly growing new health care delivery model in the United States, retail clinics have been the subject of much debate and controversy. Located physically within a retail store, retail clinics provide simple acute and preventive services for a fixed price and without an appointment. Some hope that retail clinics can be a new safety-net provider for the poor and those without a primary care physician. To better understand the potential for retail clinics to achieve this goal, we describe the sociodemographic characteristics of the communities in which they operate.
Methods: We created an inventory of all retail clinics in the United States and determined the proportion that are in a health professional shortage area (HPSA). We defined each retail clinic's catchment area as all census blocks that were less than a 5-minute driving distance from the clinic. We compared the sociodemographic characteristics of the population within and outside of these retail clinic catchment areas.
Results: Of the 982 clinics in 32 states, 88.4% were in an urban area and 12.5% were in an HPSA (20.9% of the US population lives within an HPSA). Compared with the rest of the urban population, the population living within a retail clinic catchment area has a higher median household income ($52,849 vs $46,080), is better educated (32.6% vs 24.9% with a college degree), and is as likely to be uninsured (17.7% vs 17.0%). In a multivariate model, the census block's median household income had the strongest association with whether the census block was in a retail clinic catchment area (odds ratio, 3.63; 95% CI, 3.26–4.05; median income, ≥$54,779 vs <$30,781, respectively).
Conclusions: We found that relatively few retail clinics are located in HPSAs and that, compared with the rest of the urban population, the population living in close proximity to a retail clinic has a higher income.
Introduction
Offering a novel method of health care delivery, retail clinics have garnered significant interest from patients, politicians, physicians, and health plans. They are called retail clinics because they are physically located in retail stores like grocery stores, drugstores, or "big box" stores such as Wal-Mart. Retail clinics provide walk-in care for a limited number of acute illnesses and preventative care services for a fixed price. Visits are usually covered by most health insurance plans. Generally staffed by nurse practitioners, retail clinics focus on patient convenience by requiring no appointment and offering night and weekend hours. The number of retail clinics has increased rapidly, and it is estimated that there were 3 million patient visits to retail clinics in 2008.
As the number of retail clinics has increased, several physician associations have raised concerns about the retail clinic model. They worry that retail clinics can possibly increase fragmentation of care, provide inferior care, and adversely impact the delivery of preventative care. Most retail clinics are owned by for-profit drugstore chains. Some have worried that, in an effort to increase pharmacy sales, retail clinic providers will overprescribe medications. However, policymakers, including California Governor Arnold Schwarzenegger, Pennsylvania Governor Ed Rendell, and Senator John McCain, have supported the growth of retail clinics and included them in their health reform proposals. Potential cited benefits of clinics include improving access to care and providing affordable care for the poor and underserved.
Despite the interest and controversy generated by retail clinics, there has been little empirical evaluation of their impact. The goals of this study were to describe the location of retail clinics, determine whether they are disproportionately located in areas with a scarcity of health providers, and describe the sociodemographic characteristics of the population that lives close to a retail clinic.
