Increasingly, major American merchandisers are partnering with health-clinic chains to provide routine medical services in a mall like setting.

This retail health-care trend is being led by conglomerates such as Wal-Mart and Target; by national pharmacy chains such as Brooks-Eckerd, Rite Aid, Osco Drug and CVS; and even by regional grocers such as Albertson's.

For both logistical and legal reasons, the retailers do not own, operate or directly profit from the clinics that are on their premises. Instead, outside medical providers-including InterFit Health Services (operating the RediClinic chain), Solantic, Quick Quality Care, MinuteClinic and Take Care Health Care Systems-rent space from their brand-name landlords.

These appointment-free clinics-now operating in Arkansas, Florida, Georgia, Indiana, Maryland, Minnesota, New York, North Carolina, Oklahoma, Rhode Island, Tennessee and Texas-typically charge a $25 to $60 up-front fee (only some clinics take insurance) to address a limited range of 25 to 30 acute medical conditions and common ailments-allergies; bronchitis; colds; flu; eye, ear, skin and sinus infections; headaches; and gastrointestinal issues.

Preventative care is also available, including checking blood pressure, cholesterol and body fat; providing vaccinations, physicals and weight-management advice; testing for asthma and diabetes; and screening for prostate cancer and heart disease.

The Benefits

Both retailers and health-care tenants say the clinic-within-a-store concept can be a win-win for everyone.

"We're a very customer-focused company, and customers are busy, and this will just add one more thing to their shopping list that they can do," says Sharon Weber, a spokeswoman for WalMart, the world's largest retailer, with more than 3,600 stores in the United States alone.

"And these facilities will be open the same hours as our pharmacies," she adds. "This means including Sundays. So when Junior needs a physical for the football or basketball team, the family can drop by the Wal-Mart on a Sunday afternoon and get that taken care of."

Convenience, But No Doctors

This easy-to-use approach has the potential to reshape the American medical landscape by establishing a store-rather than a doctor's office as a patient's first place of medical contact.

And that may be a problem. Many physicians' groups have expressed concern that not only are patients not being cared for in a doctor's office, but in most cases, they are not being cared for by a doctor at all.

With the exception of the Solantic organization, which maintains an in-store staff of only board certified physicians, clinics are typically operated by registered nurse practitioners and physician assistants-with physician advice limited to phone consultations.

"There's certainly no place for these clinics in complicated diagnoses, long-term management or even a second visit for the same problem," says Dr. Larry Fields, president of the American Academy of Family Physicians. "Certainly, if any of these situations arise, patients should be sent to a physician," he advises.

"It's not a solution-or even apart of the solution-for a lack of insurance," Fields adds. "In most cases, for what these places will be charging, you can see a family physician for the same problem. But, of course, these clinics are going to be open nights and weekends when the doctor's office is not open. So it's a convenience factor."

Michael Howe, chief executive officer of Minneapolis-based MinuteClinic, which operates 51 clinics throughout the United States, agrees with Fields that in-store clinics are best viewed as a convenient supplement to, rather than a replacement for, the traditional doctor's office.

"'We make it very clear to our patients that this is not a medical home," he says. "The medical home is a critical part of managing their health on an ongoing basis. We gather a list of primary care providers in the area who are accepting new patients, and we actually are involved in establishing medical homes for our patients outside of MinuteClinic.

"As we move to more consumer-managed health care, you're going to see more and more the role that these retail-based health clinics will play," Howe adds.

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