To the People

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Wednesday, May 02, 2007

CVS Seeks to Open Health Clinics In Mass., Health Officials There "Cautious"

Considering the fact that almost 50 million Americans lack health insurance and are busting the budgets of hospitals as they seek routine care in emergency rooms, one would think that CVS' plan to open primary care clinics in its stores would be welcomed by the health establishment. But in Massachusetts, health officials and doctors are "cautious" and might not approve CVS' plan to open MinuteClinics in their commonwealth.

The health care market is a mess, neglecting to serve reliably a quarter of the population while racking up costs that total 16% of GDP, and that share is rapidly climbing. Doctors' offices are very expensive to maintain and inefficient, as a few doctors need to employ a large staff to handle daunting administrative tasks and paperwork. The insured don't balk at the resulting high cost of an ordinary office visit, as they typically pay nothing or a small co-pay, but the uninsured do, and instead go to emergency rooms that have to accept them whether they can pay or not, and they often cannot or do not. The potential for large corporations such as CVS and Wal-Mart, which has its own clinic initiative, to operate low-cost clinics could be a powerful and welcome assist in lowering medical costs through scale efficiencies that small practices can never achieve and increasing access to affordable care for the uninsured.

So why would Massachusetts oppose such a seemingly positive development? From the Boston Globe article,
Massachusetts public health officials, who license clinics and must determine if they can operate safely, said they are moving cautiously on the proposal. There has been no organized opposition, but some Massachusetts doctors are concerned about the possible negative impact on patient care. They worry that serious problems will be missed when patients are treated outside their regular physicians' offices, or when they are treated by nurse practitioners and physician assistants without on site supervision from a doctor.

Dr. Allan Goroll, an internist at Massachusetts General Hospital, said the opening of clinics in CVS stores and in Walmarts in other states reflects "the sorry state of primary care in America." He said insurers underpay primary care doctors, leading to a physician shortage.

One answer, he said, is more investment by payers in primary care practices.
So Dr. Goroll, who I am sure is well-intentioned, is saying that the problem is that more money needs to be spent on office visits, and that by spending less money and thus giving more people access to health care, somehow the public will be hurt.

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