"Bodega Clinicas" Under the Gun

Offering something that resembles a real market for healthcare (with clear prices, for instance), retail clinics have grown exponentially since 2000 to somewhere around 1,200 by 2010. For many uninsured, particularly those who can't afford insurance, these clinics allow low-cost access to routine medical care - shots, primary care, and even more urgent problems like broken bones - without the long wait at the emergency room.

A somewhat unique turn for retail clinics has been the growth of "Bodega Clinicas" in California, according to Kaiser Health News. These health clinics predominantly cater to the low-income and often undocumented populations of major cities like Los Angeles. Because they manage to remain under the radar of the cities' departments of health, the clinics can offer clear, low prices for many routine services like a check-up.

This brings a slew of concerns, however, since the qualifications of the physicians practicing at such clinicas may be suspect. From KHN:

Kimberly Wyard, chief executive of Northeast Valley Health Corporation, a non-profit group [:] "They are off the radar screen," said Wyard of the clinicas, "and it's unclear what they're doing."

This creates a tough choice for public health officials, particularly with the Affordable Care Act fully taking effect in 2014 - most of these clinicas are cash-only businesses that don't accept insurance. And under the ACA, undocumented immigrants will be unable to purchase insurance through the exchanges; and the affordability of insurance will still e an issue for documented, low-income families for whom the subsidies may simply not be enough. If the clinicas are forced to change their business models because more of their patients have insurance, the prices will likely increase, potentially making them irrelevant.

The alternative to clinicas may not be palatable from both a public health standpoint and a financial standpoint - if those currently served by clinicas are left without affordable insurance and without access to the clinicas, many will likely seek care at emergency rooms - where a diagnosis of a simple cold may take hours, and the bill is ultimately covered by taxpayers.

So while bringing bodega clinicas into the fold may be desirable, officials should be careful of how they approach this thorny issue. Officials should get a better understanding of the quality of care delivered at these clinics before subjecting them to regulation. If the quality of care is no worse than the multitude of retail clinics around the country, then this should be seen as an effective model of care, for one of the most vulnerable populations. 

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