When Anita Evans from Orange City, Florida, recently stopped by her local Publix supermarket to do her Friday shopping, she noticed a sign offering flu jabs for only US$25. Less than half the price than if she had taken the vaccine at a doctor’s surgery. So she went to the pharmacy in the back of the store, where a small medical clinic run by the company The Little Clinic is located. Fifteen minutes later she had received her flu jab, paid the bill and continued shopping.
Anita Evans appreciated the convenience and the price. “This is just fantastic. It´s both cheaper and more convenient for me. Just think of the time I saved by getting my flu shot here. It would have taken longer driving to the doctor’s office. Here I didn´t even have to make an appointment,” she says.
Evans is one of thousands of satisfied customers in a growing industry of medical health clinics that are spreading through many American supermarket and drugstore chains, providing both easy access and low-cost health services. Wal-Mart has over 60 of such in-store clinics in its supercentres and it intends to roll-out the clinics nationwide this year. Target, Kroger and the drugstore chain CVS – who last year acquired an 85-clinics operation of MinuteClinic – are examples of other retailers that have opened up their store networks for clinics.

Open seven days a week
“Our clinics offer essential preventive and routine health services for our customers and are part of the solution to the health challenges our country faces, writes Wal-Mart in a press release. “The clinics also share the same commitment to everyday low prices that our customers expect from Wal-Mart. A routine visit to a clinic only costs US$40-65, compared to US$100-120 at the doctor’s office.”

"I'm saving both

money and time by

visiting the clinic.”

The medical concept of in-store clinics started as a small-scale operation in 2000. Currently there are over 15 companies in this business. The already mentioned MinuteClinic is one of them and others are similarly names companies such as The Little Clinic, QuickClinic, RediClinic and Quick Health to name just a handful. Last year the industry organised itself via the establishment of a dedicated trade organisation named Convenience Care Association.
In-store clinics measure some 10-20 square metres and due to their small size they are relatively easy to install without overly affecting the store layout.
Open seven days a week, the clinics employ nurse practitioners who can write prescriptions, diagnose common illnesses, treat minor injuries and do both medical checkups, screenings and vaccinations. Nurse practitioners also reduce costs as their wages are less than half of what a family doctor would make. Prices are transparent as the clinics have price lists for different services hanging on the wall.
Some of the common illnesses they treat are colds, skin rashes, ear infections, eczema, insect bites, warts, athlete’s foot, flu, and seasonal allergies. They also administer vaccinations for hepatitis B, flu, pneumonia and tetanus. Sport medical checkups, back-to-school examinations and blood pressure screenings are also part of the services offered.
Visits normally take 15 to 20 minutes. If the wait is longer, some clinics give the clients a pager so that they can continue shopping in the store and be paged when the nurse has time.
Clients with serious symptoms are referred a local doctor or emergency ward at the hospital. Today, approximately 10 per cent of all clients are referred to doctors.

‘Revolution’ in American healthcare
“At this time of year, I´m basically treating colds and giving flu shots,” says Rachel Smith, nurse practitioner at The Little Clinic in a Publix supermarket in Orange City. “We´ve only been open a few months but are already receiving some 25 patients a day. These people mostly appreciate the convenience our clinic offers, as we are open seven days a week during shopping hours. That’s something no doctor’s office can compete with.”
The in-store clinic trend has developed to such an extent that it is currently being dubbed as a revolution in the American health care system. The basic driver of this is cost. Over 45 million Americans are uninsured and would normally go to an emergency ward at a hospital to get the same treatment they now can receive at an in-store medical clinic. Health costs are soaring in the United States and all parties, i.e. government, employers and patients are looking for cheaper alternatives.
Another driving force is demographics, as the American population is ageing and the number of 50-70 year olds is growing rapidly. With the post-War baby-boom generation retiring, the demand for easily accessible health related services is growing side by side with the ageing population.
“We see the clinic as a service for our customers,” says Wayne Soden, Publix store manager in Orange City (Florida). “The clinic strengthens the one-stop-shopping experience and attracts more customers to our store. Many of our customers are now over 50 years old and they are looking for healthy alternatives while shopping. The clinics also benefit our in-store pharmacies, as nearly all the prescriptions that are written in the clinic will be bought in our pharmacy. Health is an important consumer trend which increasingly affects our stores. The clinics are a growing part of that trend.”
According to the trade newspaper Retail Clinician, an average in-store clinic in general increases a store’s pharmacy’s profit by US$53,000 a year. This is because 90 per cent of all consultations result in prescriptions being written. Subsequently, nearly all prescriptions are bought at the in-store pharmacy. According to Retail clinician some 65 per cent of these prescriptions are for new customers.
Customer response to the clinics has so far been favourable. In October 2006, the research company Harris International conducted an online poll among 2,245 adults for the Wall Street Journal. The result was that seven per cent of the people interviewed had used a retail clinic’s services and 92 per cent of these people said they were very satisfied with the services offered, especially the clinic’s convenience. Eighty-nine per cent of the respondents said they were satisfied with the quality of the services and the cost level appealed to 80 per cent of the retail clinic customers.

Generic medicines
Critics to the concept of in-store clinics have so far been been surprisingly low key. The American Medical Association (AMA) has not issued a formal statement on store-based clinics. However, the president of AMA, Edward Hill, has said that nurse practitioners should work in tandem with the patients’ physicians and that a minor problem sometimes can mask a more serious problem.
This has not been enough to stop patients from flocking to the new in-store clinics. “Nearly a third of all American households do not have a family physician. We see our clinics as a way of making economical healthcare more accessible to the neighbourhoods and communities we serve,” said Peter Lynch, CEO of Winn-Dixie, when the chain recently opened its stores for Wellspot in-store clinics in Jacksonville, Florida.
Medical clinics are just the latest example of how food & drug retailers are moving into the market for health and medical services. In September last year Wal-Mart began selling generic medicines for only US$4 per prescription. Generic drugs are a less expensive alternative to name-brand medicines. The average price to fill a prescription for a generic drug is US$29 according to the National Association of Chain Drug Stores, compared to US$102 for name-brand drugs. Several chains, such as Target and CVS, have followed Wal-Mart and cut prices on generic medicines.
Whether this trend – like many others in retailing – will cross the Atlantic, remains to be seen. There are known differences in consumer behaviour but the debate on health also dominates the agenda in Europe. Also in many European countries the population is ageing. In the UK developments seem to be most advanced. In February 2006, Sainsbury’s was rumoured to have a plan to house a general practitioner’s surgery at one of its pharmacy sites. Last February, Wal-Mart’s UK subsidiary ASDA unveiled plans to open in-store clinics in all its all-night stores. ASDA has around 150 24-hour stores, the majority of which have a pharmacy attached. According to the retailer, the new in-store surgeries would act as support to other local practices.
Also last February, another UK retailer – high-street chemist Boots – opened its first in-store surgery this week in Poole, Dorset. Opened between 9 a.m. and 5 p.m., it is the first in-store practice of any kind in the UK. Initially the practice will provide GP and nurse practitioner services, phlebotomy, a heart ultrasound service, physiotherapy, podiatry, an acute back pain service, dietetics and a 'managing your medicines' service.