Today I'm highlighting some health care stories that I've come across that you might have missed, covering the rise of walk-in clinics inside pharmacies and the like, insurers ideas for health reform, the use of use-it-or-lose it medical savings accounts, a report on the politics of healthcare reform, and a report on a program meant to divert people with chronic conditions from the ER to clinics.
Let's start with this one:
The rise of small walkin healthcare clinics, LA Times:
WHAT a Monday morning this was shaping up to be. Carrie Clemens' head pounded, breathing through her stuffy nose was difficult and her symptoms were worse despite a weekend of bed rest. But work beckoned -- and she had no time to visit the doctor.
And so, before checking in at her job, Clemens stopped by a small walk-in clinic at a Costa Mesa Rite Aid. There, she received a sinusitis diagnosis from a nurse practitioner, filled a prescription for an antibiotic to treat it and was out in 15 minutes.
"I can pop in here and get on with my day," says Clemens, 32, of Huntington Beach. "And I won't have to wait for hours in my doctor's office with a bunch of other sick people."
As the nation's healthcare system struggles to provide affordable care to all who need it, store-based health clinics are springing up around the country. By using mostly nurse practitioners instead of doctors, and operating in a corner of an existing business, the clinics are able to provide some basic health services for around $40 to $70 per visit -- in less time than it takes to eat lunch. Most are even open evenings and weekends, when the lights are out in private doctors' offices.
Doctors are wary on these clinics. They appreciate that they may help people get care. They worry that it will undermine a patient-primary-care-doctor relationship. They worry that the nurse practitioners and physician assistants will misdiagnose more serious ailments.
Moreover, a poll of emergency room users published in October by the California HealthCare Foundation found that 46% admitted their problems could have been handled by a primary-care doctor. Two-thirds of those patients said they would have gone to such a doctor instead of the hospital if an appointment had been available. Almost half said they couldn't get a same-day appointment.
The report also found that uninsured people often chronically use the emergency room even for minor acute-care problems. One convenient care chain has focused its services on the uninsured.
Uninsured workers, says Mandelkern, of QuickHealth, "have incomes and money to spend, they just don't have health insurance. They can't afford the $90 a primary-care doctor would cost and they sure can't afford the $400 an emergency room would cost."
"Customers love the fact that pricing is transparent," Mandelkern says. "The one thing people hate about the current medical experience is when they ask how much something is going to cost, they can't get a straight answer."
One of the things I think doctors really miss is that people are working during their office hours. There is no time for an ordinary working person to go to the doctor - or even sit on the phone trying to make an appointment. My doctor has drop in hours in the morning - and I have to say I think it's the best of both worlds, in that you could conceivably get there before work, and you can make a plan to do it the night before, when you know you're sick and need something right away. And if your problem is too complicated, they can have you come back. It all stays in the same office.
It's a great system, but it still doesn't do much for you when you realize that you're really in a lot of pain on a Friday after lunch. Why don't more primary care practices set up evening and weekend hours? If you've got 5 doctors in a practice, surely some of them can cover some different hours.
Here is a little gem from the Washington Post:
Universal Health Coverage Attracts New Support
Onetime Foes Become Unlikely Advocates, Citing Rising Costs and Tougher Access
Many are not willing to wait. Karen Ignagni, president of America's Health Insurance Plans -- the same industry association that once funded the "Harry and Louise" ads -- was among representatives of 16 business, medical and consumer groups that last week called for Congress to spend $45 billion over five years to extend health coverage to most of the nation's uninsured children. After that, the groups said, lawmakers should direct billions more toward covering uninsured adults, mostly through a mixture of tax breaks and expanded federal programs.
"On this issue, the polls show that Democrats, Republicans and independents want progress," Ignagni said. "The most expensive course is to do nothing."
John J. Castellani, president of the Business Roundtable, an association of chief executives of 160 U.S. companies, issued a similar call at a separate news conference last week with leaders of AARP, the politically powerful seniors organization, and the Service Employees International Union (SEIU). "Our soaring health-care costs put American goods and services at a significant competitive disadvantage, and they slow economic growth," Castellani said. "Policymakers must act."
Don't be fooled by this alleged change of heart as described by the Post. Reading between the lines, it's clear that Ignagni isn't advocating Universal Heath Care but instead to expand the market for health insurance. Still, it makes my heart glad that they're looking back and wondering if Hillary's plan wouldn't have been better after all.
Insurers have own ideas on coverage, LA Times
I love it when reporters let their wit show through:
Big health plans share Gov. Arnold Schwarzenegger's goal of trimming the ranks of the uninsured, but they have their own ideas about how to do it - such as taxes on cigarettes and service charges on patients every time they visit a doctor.
Perhaps not surprisingly, none would limit premiums to make insurance more affordable.
Saving the ER for real emergencies, LA Times, about a pilot program to steer "frequent flyer" patients who appear to be using the ER for chronic care into low cost clinics.
Many of these patients are homeless or working poor people. And in Los Angeles County, many are immigrants, legal and illegal. Collectively, they have strained the more than 70 emergency rooms in the county to the breaking point, helping to boost uncompensated care costs to $1.6 billion annually.
Nine ERs have closed in the last five years in L.A. County alone.
The Rush to Spend, LA Times
This little piece is an interesting coda to Bush's contention that the problem is that people spend unnecessarily on health care. Flexible Spending Accounts (NOT the same as Health Savings Accounts coupled with an insurance plan) are use-it-or-lose-it money. The byzantine rules of what kinds of spending is allowed from these accounts and what isn't makes my head spin - and I'm a rocket scientist. Personally, my favorite suggestion is that if you've "always wanted to try acupuncture," that this is a good way to clear out your account. Yes, I've always wanted my body poked with a zillion tiny needles - if only it were free!
Healthcare is definitely in the news this week, with all the various proposals floating. I was horrified to hear Bush's "plan" described as "bold" on NPR, when as far as I can tell it is neither a plan nor particularly useful. Expect more press during the rest of the week.