As its retail business matures into slower growth, Wal-Mart Stores Inc. wants to disrupt another mass market: health care. The company is piloting what it hopes will be a broad network of primary-care clinics. The company already has urgent-care clinics in about 100 stores, but the new facilities will provide much broader services such as chronic-disease management that are normally provided at a doctor's office. And it is doing so at an admirably low cost: A doctor's visit at one of its primary-care clinics costs just $40, in cash -- the only insurance they take is their corporate health plan and Medicare.
This model makes a lot of sense to me. Doctor's offices are, as the Affordable Care Act's designers frequently stressed, remarkably inefficient compared to most of the rest of the economy. There are a lot of efficiencies that can be brought to the market by a big company employing staff physicians and centrally coordinating things such as purchasing and information technology. And what is Wal-Mart very good at? Central coordination of purchasing and IT.
The price of that is that when physicians are staffers, they will probably work hours like staffers, meaning that you may not be able to get an appointment with a particular doctor. Health-care advice usually stresses that you should find a good primary-care physician.
But let's be honest: My primary-care physician has no idea who I am when I walk in the door, having last seen me at least a year ago. I mean, maybe she remembers me because I'm extra-tall, but frankly, even that rarely happens. She is assessing my condition by listening to me and reading my medical records, something that could just as easily be done by a completely different doctor. If you're chronically ill or elderly and a trip to the doctor's office is a regular event, then it's probably useful to have one person coordinating your care who knows you and who will take a consistent approach. If you're the sort of person who mostly checks in to get your hypertension medication or statin prescription refilled, then having one doctor probably doesn't add much benefit.
On the other hand, increased access may really matter; we're a busy lot, we middle-aged people with chronic health problems. Having clinics conveniently close by, at a low cost and with the ability to schedule an appointment with someone relatively quickly is probably a much bigger deal than finding a top-notch physician we really click with.
That doesn't necessarily mean that Wal-Mart will be the one to deliver this service to the masses. History is littered with corporations that were very, very good at one thing and decided, erroneously, that this would make them very, very good at being in an entirely different industry. Wal-Mart may find that for any number of reasons -- expertise, regulation, internal politics -- that it can't crack open the health-care market as easily as it did retail. But I hope that someone will succeed even if it fails.
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