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Can Retail Minute Clinics Replace Primary Care?

· healthcare,pharmaceuticals,insurance,govt policy,medicare

Recently, I was reading in the news about a South Korean couple who was visiting San Francisco with their toddler son, and after visiting the Zuckerberg San Francisco Hospital for a slight bump on the head, in which the boy ended up received a bottle of formula, they received a bill of $18,836. $15,666 had been for triggering “trauma activation” and $3170 was apparently charged for the toddler’s examination by doctors and the baby formula he received whilst taking a nap in his mother’s arms at the hospital for a few hours.

I think this case highlights the extraordinary increasing costs of emergency care under a for-profit system in which healthcare is treated as a commodity. Critics of this system have not only been patients, but it has mainly been doctors who have been the most vocal about their discontents. Under this system of management, doctors have made complaints that their performance review was based on how many hospital beds they fill, how many drugs they prescribed and how many surgeries they performed in a quarterly period. Doctors who do not meet this quota in the for-profit model of healthcare are often under threat of losing their jobs. Due to the incentives and organisational controls that adversely affect the physician-patient relationship, this creates a conflict of interest that ultimately diminish the quality of care and erodes the patient’s trust in their physician and the public’s trust in the medical profession.

In addition, due to the increasing workload that is placed on doctors under this system, they do not have enough time to update their education and focus a portion of their time on research, which is what is necessary in a fast-paced sector such as medicine and healthcare, where many innovative technologies and treatments are primarily being developed at universities but not implemented in a clinical setting.

Retail minute clinics could replace primary care at hospitals for management of chronic diseases such as diabetes, hypertension, seasonal flus and minor injuries.

However, hospitals are also undergoing another revolution; due to the increasing costs of primary care and the rise of insurance premiums, more and more Americans are turning to retail minute clinics for their primary care needs. This creates a shift in dynamic in which hospitals are evolving to become emergency care centers and specialised services for research in idiopathic diseases, whereas the minute clinic serves the needs of the widespread public for management of their chronic diseases.

For-Profit Model of Healthcare or Socialised Medicine?

In the UK, the National Health Service (NHS) was formed in 1948 after WWII, when members of Parliament voted to launch socialised medicine and universal health care for all. During WWII, when many different social classes had been united to fight a common enemy, a sentiment of equality for all began to take shape and the concept of universal health care had been borne. Today, the NHS is under threat, and many UK politicians have suggested following a for-profit model, such as the United States without going so far as to say they will abolish the NHS. Prime Minister Theresa May has said that she would like greater involvement for US corporations in British healthcare during trade negotiations, in which she has been criticised for mimicking a US for-profit model of healthcare that incentivises corporations and shareholders.

However, although socialised medicine initially appears to have many benefits, I also think that under socialised healthcare, a lack of choice may be present under a system in which the govt primarily controls what kind of healthcare patients may receive. In the United States, despite numerous flaws in the healthcare system, people have the freedom of choice to pursue many different options in their healthcare; whereas, in nations that have implemented socialised healthcare such as the UK, France and Canada, people may be forced by law to undergo treatment or prevented from having the freedom to pursue other options in their healthcare.

If we take the recent examples of Baby Charlie Gard and Isaiah Haastrup in the UK, parents were forced to allow their children to die by hospital administrators and did not have the choice to pursue further treatment elsewhere, even when one of the parents had raised enough funds to pursue treatment in the US, the UK courts had stopped the parents from doing so.

President Trump weighed in his opinion and tweeted in support of helping baby Charlie Gard, contradicting the UK courts that demanded that Charlie Gard be taken off life support.

In addition, nations such as France have recently passed a mandatory vaccination schedule for children, in which 11 vaccinations have become compulsory and parents are legally obligated to vaccinate their children. Vaccinations have been an area of controversy for decades, however, with the advent of personalised medicine, and epigenetics, it has been discovered by researchers that certain people have genetic predispositions that may make them adversely affected by vaccinations. Due to the fact that children with weakened immune systems also react adversely to vaccinations, it would be dangerous to mandate vaccinations for all babies and children as a “one-size fits all” rule. Mandating vaccinations without first genetically screening babies and children would be putting their lives at risk and increase the likelihood of adverse effects.

Acute cerebellar ataxia following meningococcal group C conjugate vaccination. There have been many reports of delayed or stunted development of the cerebellum in the developing brains of young children after vaccination. This anomaly could be explained by the genetic predisposition of certain children who are at risk or who have weakened immune systems in which they suffer adverse effects of vaccination. This situation could be remedied if pharmaceutical corporations were to genetically profile and monitor each child before vaccination, so that at risk children are exempted from vaccinations.

Although, socialised medicine has been idealised in the media, due to increasing costs of care in the US, and popularised by the films of Michael Moore, upon closer examination, the lack of choice present in patients under a socialised healthcare system may endanger civil liberties. People should have the choice to pursue which type of healthcare may be best for them, and for governments to interfere and force patients into a specific type of treatment against their will is moving towards an authoritarian society that impinges upon freedom of choice and self agency, in addition to becoming a threat to global capitalism.

The Information Age and Rise of Personalised Medicine

Just as Google revolutionised access to information, it is becoming clear that personalised medicine, and not a “one size fits all” treatment model of healthcare will become the norm in the future.

In 1993, when Former First Lady Hillary Clinton set out to reform healthcare and testified in a Congressional hearing, she said that there was no difference in the quality of care that patients receive despite the large differences in payment under the American healthcare system. This could be explained partially by the lack of personalised healthcare at the time in which patients were treated the same for various illnesses without assessing their genetic profile. A drug and dosage that works for one patient may not be effective in another patient, just as vaccinations can have adverse effects on children with a particular genetic makeup whilst not affecting others. However, since the age of antibiotics, global healthcare has mainly revolved around a platform in which patients are given similar dosages of similar drugs in a “one size fits all” model.

However, now as medical treatment is moving towards immunology and personalised healthcare, pharmaceutical corporations and academic institutions have been involved in research that moves beyond the drug industry into areas such as optogenetics, enzyme replacement therapyin situ vaccinations, development of human organs in laboratories and ultrasound surgery, a type of non-invasive surgery.

For the last 200 years, invasive surgeries in which cutting a patient open to operate has been the norm. However, now, doctors are able to use MRI guided ultrasound surgery to be able to perform surgeries without cutting open a patient.

Medical innovations such as these are developed from partnerships with universities and hospitals, and it is clear that as hospitals become centres for research with less focus on primary care, that the gap in the market will be provided by retail minute clinic outlets to serve the public’s needs.

It has been widely documented that overworked doctors at hospitals make mistakes, which can often lead to catastrophic results and leads to the deaths of patients in which medical errors have been said to be the 3rd leading cause of death in the United States. The NHS in the UK is facing a similar crisis as doctors are forced to work extra hours due to a lack of funding.

However, with the rise of retail minute clinic outlets, this separation of emergency care vs. primary care allows doctors with specialisations to focus on treatment of idiopathic diseases and research into innovative treatment methodologies at the hospital setting, whilst nurse practitioners at minute clinics can address the management of chronic diseases with a focus on preventative medicine.

By utilising a combination of both for-profit medicine and government funded research, hospitals can serve as non-profit entities, similar to research universities whilst retail minute clinics can fill the gap of primary care. This allows innovation at the highest level, and allows a wider dissemination of primary care that is available to a greater portion of the public, making healthcare affordable for patients, whilst at the same time satisfying shareholders and investors of pharmaceutical corporations.

Under this system of capitalism, giving the patient the power of a consumer; and utilising a combination of both for-profit and nonprofit healthcare whilst separating the institutions that provide emergency care (nonprofit) vs. primary care (for-profit), patients would have a choice in the type of care they want to receive and not be forced to undergo treatment against their will, as what has been occuring in nations with socialised medicine such as the UK, Canada and France, in which the government has the power to dictate what type of treatment a person can have.

How Pharmaceutical Corporations and Insurance Companies Can Pivot In the Era of Preventative Medicine

When President Trump was elected, he had a platform to “come down hard” on pharmaceutical corporations. He had a plan to take on the “tangled web of special interests” that drive up drug prices, noting the high amount that pharma companies spend on lobbyists to “protect the status quo” and “keep drug prices high.” He also cited supply chain middlemen for getting “very rich” under the current system and promised regulatory and legislative changes to address the status quo. Under the leadership of Secretary Alex Azar, a former pharmaceutical executive, President Trump’s policies “stopped short of giving the government authority to negotiate Medicare drug prices or liberalizing curbs on drug imports, policies strongly opposed by pharma".

However, although focusing on limiting drug prices may be a noble effort, I think instead by focusing on the patient, and allowing patients direct and immediate access to information in their medical history across multiple institutions and databases, including access to all the doctor’s notes in their file would be giving the patient a higher amount of control in which services they would want to choose for their primary care. Patients should have direct and immediate access to their entire medical history so that they can be informed about a wide variety of treatment options in order to choose the type of treatment that they want. By being informed about their own medical history and by having access to doctor’s notes, patients can have the choice to make their own decision about what’s best for them.

Brazil's Yoshiyuki Shimizu (R), France's Michel Claverie (C) and Germany's Wolfgang Reuter (L) compete in the men's 100m final for athletes between 85 and 89 years old, during the World Masters Athletics Championships (From the Telegraph). The reason for longevity in certain populations have been overwhelmingly due to a physically active lifestyle. By shifting Medicare to focus on sports and active lifestyles rather than on drug coverage could radically alter the quality of life in the elderly population.

In addition, currently Medicare only covers a limited portion of physical and occupational therapy. However, Medicare would be more cost effective in the elderly if it was integrated alongside physical rehabilitation services with a focus on sports and active lifestyles, instead of what is occurring at the present time in which the elderly are often bedridden at hospitals on multiple drip medications, waiting to die. Instead, Medicare would be more cost effective if it were utilised across different occupational services, so that it could be easily integrated with physical therapists and retail gym outlets to encourage the elderly to become active members of our societies instead of primarily focusing on Medicare to cover drug costs. If Medicare covered group athletic activities, specialised one-on-one gym training sessions, and increased in coverage as the elderly becomes more active in local volunteer organisations, this could radically change the quality of life for many elderly people, who are often isolated, only to spend their last days bedridden in the hospital.

This also provides an opportunity for health and medical insurance companies to cater their services towards seniors, so that part of the insurance coverage can offer services such as local gym memberships, lifelong physical therapy services and preventative medicine education. In this way, insurance companies can move the focus from covering short-term medical treatment primarily based in the hospital setting, and move towards long-term care that targets the elderly’s entire lifestyle, creating more value for shareholders and investors, in addition to improving the quality of life for seniors.

The global wellness economy was $3.7 trillion in 2015 and grew 3 times larger than pharmaceutical industries and projected to double over the next decade. This presents an opportunity for insurance companies to cater to specific lifestyle needs of the elderly and for pharmaceutical corporations to move from a “sick care” model of healthcare to a preventative model of healthcare that focuses on personalised medicine with more frequent preventative screenings.

In every part of the world that has documented the longevity of its people, it has been noted that they all lead physically active lifestyles. Much of my insights about elderly care comes from my direct experience with the passing away of my father last year. What my father didn’t need were more drugs nor to be immobilised on a hospital bed. What my father needed was physical therapy and have a community of other elderly people to be physically active. What my father needed was more frequent preventative medical screenings and not merely a short annual checkup. I still have so many regrets about the way in which my father passed away. I hope one day, we can all come together; insurance companies, pharmaceutical companies, and politicians to shape government policies, in order to improve the quality of life for our senior citizens, because the longer the lifespan of a patient who is active in society, you have a customer for life.

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