Several weeks ago, I wrote in support of the establishment of storefront clinics in the state. That post generated a lot of back-and-forth and good discussion. I recognize and respect the full set of views. It is an interesting public policy question.
Since then, the state DPH has held a hearing on the matter and also received lots of comments. Most recently, a letter was sent in from several groups outlining their list of suggested requirements for these clinics. The signers included representatives from the MA Medical Society, the MA Academy of Family Physicians, the MA Chapter of American Academy of Pediatrics, the MA League of Community Health Centers, and MA Hospital Association.
I hold no brief for the applicant -- other than joining with lots of friends and neighbors who this is a good idea for the public -- but I have to think that many requirements the opponents would seek to impose on the clinics would make them uneconomical or impractical. The letter writers would surely state that their only interest is insuring the public health. But the nature of the comments suggests more than that -- that the protectionist view I thought would come to the fore has indeed done just that.
I can't go through the whole letter here, but here is a sample comment.
"There is also large concern about the mix of patients that the MinuteClinic will take and the impact on the health care system as a whole. While the representatives indicated an intent to care for all patients regardless of their ability to pay, there is no indication that they will be established in an area with public transportation or a concentration of indigent patients. The Department should also strongly review the referral patterns and payer mix of these stores to ensure that if they have a full clinic license they will have the capacity to respond to the needs of all walk-in patients from the community and not just those that generate low risk and complexity visits."
Heads, we win. Tails, you lose. Previously, some commenters were worried about the effect of the clinics on the community health centers, which are often located in areas with public transportation and a concentration of indigent patients. Now, with the applicant avoiding those areas and focusing on the suburbs, they are essentially criticized for not competing with the health centers.
And what is a "referral pattern" for a walk-in clinic in a drug store? And how would you review such a pattern for clinics that do not yet exist? Would you look at who recommended that people buy their shampoo at this drug store? Or which doctors submitted prescription orders?
And, why should the clinics have the capacity to respond to the needs of all walk-in patients, when they are designed specifically not to do that? They made clear that they would quickly and helpfully make referrals to emergency rooms and doctors when they were presented with medical problems beyond their capability.
In summary, these clinics have worked in other states. Why are my colleagues so averse to letting Massachusetts give them a try, too?
[Disclosure: I recently was asked to join the Board of the MHA, but I was not involved in the decision of MHA to participate in this letter nor in its decision to take the position it has on this issue.]
