We really aren’t much interested in retail clinics.
No, really. We’re not.
Or in health care generally, for that matter.
What we’re interested in is how solutions to people’s problems emerge in situations where no one is “in charge” of making them emerge, no one in control of the power to make them emerge in a specific way.
Health care solutions are compelling for us, because, well, we really don’t know why specifically, but partly because everyone we know or can imagine has some level of health, that sometimes needs care. That universality – coupled with the gigantic variation in what people may mean when they speak of ‘health’ and ‘health care’ – fuels our abiding interest in health care and health care innovation. So for us, interest in retail clinics is practically inevitable.
One ramification of this incidental interest in health care is observing how often it happens that when a person or persons talk about health care solutions, what it turns out they’re talking about is solutions having little to do with health or health care.
The Centers for Disease Control’s pronouncement today that swine flu vaccine should be distributed through workplace clinics among many other venues to get it to high-risk people as quickly and efficiently as possible is one of those instances.
Sure, CDC officials want to head off a swine flu epidemic, so the announcement IS “about health care”.
But their proposed solution is about….ease & convenience. They say so themselves:
“There’s nothing wrong with an employer-based clinic,” Dr. Schuchat said. “When you look at adults and where they get vaccinated, it’s a common place. It’s convenient.”
Of course, the particular convenient places for distributing swine flu doses that got the most attention were the workplaces of Wall Street bankers at firms like Citigroup and Goldman Sachs, & that these locations were getting small supplies of vaccine before other, less-well-appointed places like hospitals & pediatricians’ offices. Hence this pronouncement constituting news. So there’s certainly more to the story, as they say; Saturday Night Live among many others, had a field day with the “rank favoritism for the bankers” angle.
But that doesn’t negate the plain facts of the doctor’s observation. Put vaccines where people fitting the category of ‘most susceptible to the target health condition’ are likely to be. Make it easy for them to run into the needle. Because doing so will be good for everyone, not just those who get stuck.
We’re completely sympathetic to the contention that it is unfair to supply fat-cat bankers with vaccine when others whose needs are routinely ignored may yet again be discounted in this instance. At the same time….We’re not epidemiologists, but it seems that an important thing to do is get vaccine to people with the greatest likelihood of causing calamity should they contract the illness, and one such group of people would seem to be those with a high rate of interaction with numbers of other at risk people. It’s not so much WHO they’re interacting with (though the share of at-risk people among their interactions would definitely merit attention – hence the interest in vaccinating health care employees), it’s the NUMBER of them that would seem to be the most important variable. Working people would seem to be one such group.
And somewhere in the mix is that old reliable element, convenience. Convenient can mean economical, efficient: it’s just easier to get dosages to high-risk groups reliably via a place where people are already habituated to attending to schedules (for meetings, for vaccinations), have sufficient organizational trust to readily roll up their sleeves for shots, etc. Good for the fat-cat bankers, good for society. And “good-er”, at least arguably, than other options for accomplishing the same overall purpose.
But note: the contentious issue has little to do with health care specifically. It has much more to do with “stuff” that surrounds “health care” – the logistics, if you will, of making it possible to generate the optimum clinical benefit of the vaccine.
And that’s what we’re interested in. Retail clinics, in this sense, are much less about “health care” than about solving basic problems of ease & convenience – of rationalizing delivery of what everyone, including doctors whose own ways of delivering the same care are jeopardized, would agree is pretty simple, pretty basic, pretty valuable “health care”.
30
Mar 10
Workplace Health Clinics: Work In Progress
In this case by work we mean research on large employers’ use of workplace health clinics, currently being conducted by The Center For Studying Health System Change, and led by Ha T. Tu with grant financing from the Robert Wood Johnson Foundation’s Changes in Health Care Financing & Organization initiative.
The researchers will examine six research questions (detailed here). We’re most interested in the answers they discover to this one (#2 on their list):
The report is due for completion by June 30, 2010. Stay tuned….