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The Revolution in Health Care Delivery
Does Your Doctor Sell Cigarettes?

Answer: Probably not. And now neither will CVS, which has announced it will no longer sell tobacco products in its stores.

This story is about more than the crusade against Big Tobacco. More importantly it’s a sign that CVS will increasingly be making business decisions on the assumption that it is a major provider of health care:

“We have about 26,000 pharmacists and nurse practitioners helping patients manage chronic problems like high cholesterol, high blood pressure and heart disease, all of which are linked to smoking,” said Larry J. Merlo, chief executive of CVS. “We came to the decision that cigarettes and providing health care just don’t go together in the same setting” […]

A shortage of primary care doctors and expanding access to health care coverage under the Affordable Care Act is turning drugstore chains into big players in the nation’s health care system. Consumers routinely get flu shots in drugstores, for instance, and clinics staffed by nurse practitioners or physician assistants and offering basic care for common ailments like strep throat or pink eye are popping up everywhere from Walgreens to Walmart.

Big box clinics are good for health care delivery in a lot of ways. When it comes to certain kinds of primary care, they’re less expensive than a doctor’s office (sometimes by 30 or 40 percent), due to their heavy reliance on nurse practitioners. With the demand in health care rising under the ACA and primary care provider shortages popping up across the country, outlets like CVS can help fill the service gap and shift our system’s center of gravity away from hospitals while they do it.

If big box clinics get in the health care innovation business in earnest, it could generate some real progress toward bending the health care cost curve.

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  • Anthony

    The points made in this post are good, but Professor Mead seems to be avoiding the bigger issue. He constantly talks about the ability of nurse practitioners and physician assistants to reduce health costs. And while this is obviously an accurate observation, no mention is made of the fact that major procedures are the main driver of healthcare costs. Are we going to have nurse practitioners performing open heart surgery? Professor Bhagwati, who regrettably no longer writes for The American Interest, had a good idea that, to my knowledge, has not yet been taken up by Professor Mead.

    He thought that patients should be encouraged to get surgeries done in foreign countries such as Thailand, where doctors who have completed a residency in America are available in first class facilities at a significantly lower price than their counterparts here in America. If this idea intrigues you, I suggest watching the 60 minutes episode on healthcare tourism, which is available on youtube. It shows Bumrungrad hospital in Thailand, which looks outstanding. Not only is it much cheaper for patients paying in cash, they actually get a much more luxurious experience than is available in America.

    • Andrew Allison

      Like most people, Prof. Mead (or, perhaps, the flogees) is not thinking clearly about healthcare. Specifically, he not only conflates the delivery of healthcare with the entirely separate problem of how it’s paid for, but tends to tar all providers into the same brush. As you point out, primary care is not the primary (sorry) problem.

      The difficulty with medical tourism is that the patient has to pay the bill in full at the time of service and, if insured, attempt to get reimbursed. Insurance companies could save a lot of money (and put pressure on domestic providers) by agreeing to pay approved foreign hospitals for non-urgent procedures (hips, knees, heart by-pass, etc.).

      A simpler solution might be for insurance companies to publish the amounts which they are actually reimbursing for standard procedures and do away with the entirely fictitious billing by hospitals and specialists. I’ve seen estimates that it’s about 30% of the list price.

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