My doctor’s name is Wal-Mart

Filed Under: Costs, Health plans, Patients

“Can Wal-Mart provide us with health care as efficiently as it furnishes us with paper towels?” asks John Goodman over at the National Center for Policy Analysis.

As much as anything, this may be another symptom of the crisis in our health-care system. Costs keep rising. More and more people are uninsured. The effects of rising costs are limiting access to care, even as they threaten people’s finances, as well as the finances of governments, schools, villages, businesses.

Here at ClearHealthCosts, we don’t profess to have all the answers. But we do have one Very Big Answer to a Very Big Problem

We think people should know what things cost in health care. You shouldn’t have to enter the health-care system — which you most often do when you’re ill, because if you’re healthy there’s less reason to be there — also worried about money. But for most of us, insured or uninsured, that’s what happens: we worry about money. And we think you should be able to know the answer to a simple question like this: How much does an M.R.I. cost?

So seeing Wal-Mart thinking about entering the health-care system isn’t so much a surprise. Goodman writes: “According to a Kaiser Health News report, Wal-Mart — the nation’s largest retailer and biggest private employer — now wants to dominate a growing part of the health care market, offering a range of medical services from basic prevention to management of chronic conditions like diabetes and heart disease, according to a document obtained by NPR and Kaiser Health News.”

Wal-Mart did say in a statement, according to Goodman, that “we are not building a national, integrated, low-cost primary care health care platform,” but that leaves a lot of questions up in the air.

Among the things Wal-Mart is famous for are low costs and easy access to goods.  Much of what’s wrong with our health-care system today has to do with high costs and limited access. (This piece by Aaron Carroll over at The Incidental Economist points out that a lot of people wait a long time to see their doctor when they’re sick.)

Urgent-care clinics on the order of the Minute Clinic have taken over big swaths of the primary-care market in many places, and they indeed are on the rise in New York. (Here’s our urgent-care clinic roundup of the scene in New York.) There are now about 1,300 urgent-care clinics around the U.S., Sarah Kliff writes on Ezra Klein’s blog, and they continue to grow in number and popularity.

The reasons? You can get there fast, but perhaps more inviting: the prices for a visit are often clear — quite often they’re posted. For a sore throat, if you’re in a hurry, the allure is undeniable.

Insurance companies like urgent-care clinics too — the costs for an urgent-care visit for a sore throat are considerably less than they would be at a hospital emergency room, which perhaps explains why my insurance card has added a co-pay for an urgent-care clinic to the previous standard menu of three co-pays (primary care provider, specialist, emergency room).

And Wal-Mart can use the clinic to bring traffic into the store. Wal-Mart is a smart retailer, and their move into this marketplace could signal a seismic shift.

Which brings us back to one of John Goodman’s primary point. One reason Wal-Mart could make inroads into the health-care system is that the current health-care system, with its third-party payment via insurers, has brought us to the current situation: limited access and high prices. The incentives are wrong: insurers, providers and patients all have separate agendas, meaning for instance, that a for-profit insurance company has an incentive to pay a provider less and cover less care for an insured person, while an insured person wants the best care at the lowest price, perhaps encouraging overuse (because that insured person isn’t paying the bills).

(While we’re on the subject of Wal-Mart, a few weeks ago they cut back health-insurance plans for a number of their workers.)

So we see  Sam’s Club offering health screenings in volume in June: Free, with no waiting, they offered body-mass index measurements, blood pressure tests, cholesterol readings, PSA (prostate cancer) tests, and TSH (thyroid stimulating hormone) tests. The monthly schedule from then on included kids health screenings in July, vision health in August, diabetes screenings in September, women’s health in October and digestive health in November. January: New Year, new you!

Urgent-care clinics tend to take a lot of cash customers, cutting out the third-party payers. Quality? Continuity? Well, hm, that’s a separate matter.