Dr. Kevin Pho

WASHINGTON -- Ever need to treat a cough and buy a toaster, all in one trip?  Wal-Mart can make that a reality, as the chain has announced it will greatly expand its in-store health care business. 

The company plans to open 400 clinics in its retail locations by 2010 as part of its “commitment to providing affordable, accessible solutions to America’s healthcare challenges,” according to a company statement.  The first clinics will open in Atlanta, Little Rock and Dallas this spring.

Wal-Mart joins fellow retailers Target, CVS, Rite Aid and Walgreens in the outpatient medical services industry, a trend that could shape how Americans get health care.

Rather than wait hours to see a doctor or make an expensive trip to the emergency room, patients can now walk in to clinics without an appointment for treatment of minor illnesses like strep throat, colds and flu.  Don’t expect to see medical degrees on the examining room wall, though; In-store clinics in retail locations are typically staffed exclusively by nurse practitioners.

Prices are set for treatments and are in most locations displayed prominently, so patients know in advance how much services will cost.  In-store clinics also accept most health insurance coverage plans, such as Blue Cross and Aetna.  Most conveniently for the patient, and profitable for the retailer, the pharmacy counter is just a few feet away to fill any prescriptions. 

It’s an effective business strategy for companies that made fortunes selling remedies to now move into diagnosing ailments.  Upfront fees and low-cost alternatives to doctor’s offices and hospitals may appeal to a large portion of Americans, particularly those who lack adequate health insurance. 

According to the National Center for Health Statistics, more than 42 million Americans have no health insurance.  But, that doesn’t stop people from seeking medical treatment, as 42 percent of uninsured Americans visit health care providers one to three times a year.

In 2004, the average American with private health insurance spent $275 out of pocket on medical expenses. The uninsured American: $465.  Getting sick is tough, but paying to get well may be even tougher for many. 

This hardship can translate into big business, however, as the American health care industry tops nearly $2 trillion each year.  That kind of payoff may prove a tempting target for Wal-Mart, a company that has built itself up on its ability to offer lower cost alternatives for almost everything.

But what’s good for big business may not always be good for the people.

Many doctors and lawmakers nationwide have reservations about the growing in-store medical trend.  Last June, the American Medical Association called for investigations into potential conflicts of interest in joint ventures between store-based health clinics and pharmacy chains.  The concern is that in-store clinics will only prescribe medications offered at their own pharmacies. 

“There are clear incentives for retailers to participate in the implementation and operation of store-based health clinics,” said AMA board member Peter Carmel, M.D., in a statement.  “The nation’s physicians want the AMA to ensure these incentives do not compromise the basic obligation of store-based health clinics to provide patients with quality care.”

The AMA also expressed concern that retail health clinics may overlook patients’ more significant health problems in the quest for speedy service, and urged federal and state regulatory agencies to examine them more closely. 

In January, Massachusetts became the first state to develop a set of guidelines for in-store clinics.  The new regulations require that the state health department review and approve every clinic application as well as staff credentials.  The guidelines also require that in-store clinics develop policies for referring patients whose treatment needs go beyond the clinic’s services. 

Patients aren’t the only ones potentially at risk from the in-store clinic boom.  Doctors themselves run the risk of being closed out like so many other businesses in Wal-Mart’s mammoth wake. 

“There are a lot of doctors who see (in-store clinics) as a threat because these clinics skim off quick visits and leave behind more time-consuming cases,” said Dr. Kevin Pho, an internal medicine physician in New Hampshire.

Describing the problem as a “perfect storm,” Pho says the in-store clinic boom capitalizes on physician shortages and lack of access to primary care doctors.  “They definitely fill a need.  It goes to show there aren’t enough primary care physicians out there when you have people waiting weeks for an appointment.”

But this doesn’t mean doctor’s offices will become a thing of the past.  Many physicians are already adapting to this industry trend by partnering with retail clinics as referrals when patients need further care.  “As a primary care physician, you could either see it as a threat or an opportunity,” said Pho.

Currently about 7 percent of Americans have tried a medical clinic at least once, according to the industry trade group, Convenient Care Association.  But, with an explosion in the number of walk-in medical clinics in the U.S. in the last year, from 160 to 920, that percentage is sure to go up. 

With nearly $2 trillion up for grabs, Wal-Mart and its retail brethren are willing to bet that convenience and low-cost services have a place in healthcare’s future.