Department of I don’t see why we don’t have more of this

Frustrated by runaway health costs, the nation’s largest employers are
moving rapidly to open more primary care medical centers in their
offices and factories as a way to offer convenient service and free or
low-cost health care.

Here is more.

Comments

FYI, IBM has always had it's own medical office.

I have to disagree with Bruce. I work for Sprint at the Overland Park campus (Kansas City), and the clinic is top-notch. The bad old days were a case of less for less.
Given the extraordinary cost of health-care, clinics such as these are more for less.

This indeed sounds like a regressive idea... One of the problems is that health care was unwisely linked to employers in the first place, a poor decision we are now paying for as people switch jobs more and more. Health care delivers true value when it has a long-term interest in the person's well-being, something you won't get from a stop-and-shop company store that expects the employee to leave (willingly or otherwise) shortly thereafter.

Oops, I meant to strike out lodge.

John Thacker:
I think it's simpler than that. Big companies already have departments devoted to fighting with insurance companies and making them pay what they've promised (which is a big advantage to having insurance through a big company!). Coverage through clinics avoids these fights.

Presumably, if the clinics are free or cheaper and there's no requirement to go there first, then this is in no way regressive. The whole problem with the company store was being forced to use it.

I can see the plaintiffs lawyers salivating over these clinics. Most of them are staffed by nurse practitioners to save money, so the company would become the deep pocket in a lawsuit. I see it as a huge liability for the companies-there is very little they can do to screen themselves from being dragged into a multi-million dollar medical malpractice case, which will happen eventually.

I assume at least part of this is to avoid some of the cost-shifting games, where doctors try to shift costs of nonpaying or low-paying customers onto the paying ones. The IBM clinic doesn't have to figure out how to shift the unpaid costs of their Medicare or Medicaid patients onto the rest of the customers, because they don't have any.

Perhaps another reason for this is to discourage job-hopping. The link between jobs and insurance does this to some extent, but in practice, I'm not taking a job without insurance. But if I have to change doctors, too, maybe it's harder to leave.

Another benefit for the clinic is that working people tend to be relatively healthier, more put-together, and for most companies, working there pretty-much ensures you're literate and not terribly stupid. All those decrease the costs/difficulty of providing care. If you're running a clinic for Microsoft employees, you've probably got a population of patients with college degrees and IQs averaging around 120. You can give them detailed instructions and have them understood and correctly followed.

Christopher, I think you have the dynamic wrong. Most employers now actually are concerned about the well-being of their employees, for the bottom-line reason that unwell employees are more expensive. They miss work more often, they are less productive, and they hurt insurance rates. That's why even small employers like mine offer "wellness" plans that encourage employees to eat right, get flu shots, etc. I'm not saying anyone's getting it right, but they're responding to incentives and trying to get it right.

The examples in the article suggest that employer clinics, which have been around for a long time, are for basic things akin to the minute clinics that are opening in some large retail stores. They may work well for some things for some people. People needing advanced medical care are going to have to go elsewhere. Then there is the incentive problem--docs who work for employers face different incentives than physicians who work for patients. People will probably continue paying cash for consultations over medical problems that they do not wish widely known. Thanks to HIPAA, medical records are not private. There is a routine exemption for cost control purposes, for example. Finally, there is little systemic evidence that preventive care reduces overall expenditures once you get past routine childhood immunizations and push things past the clinical trial stage. Screening costs money, too.

I really wonder how much of this is health care specific and how much of it is an instance of the general phenomenon of errand-time-saving. Employers realize that for many workers, a major component of non-on-the-job time is time spent doing various necessary errands and traveling to and from same. The travel component is annoying and subtracts both from free time and from working time; so if they can reduce it by putting errand-type services at the workplace where employees are going to be anyway, the employees will work longer hours and also feel they have more satisfying and relaxing leisure time.

My own employer carries this to something of an extreme: besides the onsite food and clinic we have onsite dental services, haircuts, car washes, oil changes, massages, et multae cetera. But the fact that many of these services are outsourced to contractors who serve many local companies on a rotating basis (e.g. the RV with the mobile haircut station stops by every Thursday) suggests that this is catching on.

But doctors aren't your employees now, either. They are paid by your insurance agency, which effectively determines how much time they have per patient.

Companies such as SAS in North Carolina, Storagetek in Colorado, IBM in New York have had on-site clinics for years. THe employees I have spoken to about them love them. They get good care, do not miss work, get generally competent doctors. If the employees like them and the employer saves money and gets higher productivity, what is not to like?

As for Peter Clay's question, when you change firms frequently your doctor is not on the new company's insurance plan and you have to switch doctors. How is that any different? There are trade offs to every action, this just happens to be another one. Your records will transfer to the new doctor and they can continue you on the drug regimen.

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