Clinical Approach

Whether it's a broken bone or a routine rash, where can you go for proper, timely care? The emergency room often doesn't make sense for these smaller hurts and who wants to wait until the next morning for an expensive and time-consuming doctor's office visit?

This column was triggered by the recent experience of a good friend of mine. She has a 12-year-old budding youth football superstar.

She and her husband are self-employed, and have naturally (and wisely) avoided the $13,000 annual full-coverage health insurance premiums by using a high-deductible health plan and a health savings account. One evening, at the end of practice, her son got a 3/4-inch long and deep chin laceration. A real bleeder. Not knowing what else to do, she headed to the local emergency room.

The emergency room admitted him and naturally, without talking price, put eight stitches in his chin and fed him a late dinner.

The bills started coming shortly. First, $273 for the stitches from the attending physician. Then, $85 from the primary care physician for removing the stitches. And then, the heartbreaker -- $848 from the hospital for the emergency room visit. If you're keeping score, that's a total of $1,206.

Shortly afterward the family checked out the local urgent-care clinic, open until 8 p.m. on weekdays, which would have worked fine. Cost: $222 -- including the follow-up visit to remove the stitches.

A stitch of today's health care
For me, this incident reinforced a lot of what's wrong with the health care system. First, outrageous costs - over $1,200 for a one-hour ER visit. Second, the inevitable "morale hazard" that drives up these costs.

There are two types of ER users - first, the true emergencies -- quite necessary. But to stitch up a chin? A sprained ankle? Strep throat? Sure, these things get fixed in ER too - for fully insured patients more concerned about convenience than cost. That luxury ends up being subsidized by others - those who pay for full coverage and the few unfortunates taking the out-of-pocket hit.

OK, I'll dismount my soapbox. The real point here is not to change the system but to show how you can contain costs. Regardless of your current coverage, sooner or later inevitably you'll foot a bigger portion of health costs out of pocket. If you're smart about the alternatives, you'll come out ahead.

Alternative No. 1: Urgent care expands boundaries
Urgent-care clinics -- called "McDoctors" by some pundits -- have been around for years. Usually in suburban retail locations or close to health-care complexes, they're most often staffed by an M.D. and handle patients on a walk-in basis.

Originally, most were set up to handle injuries -- break a bone, get an x-ray and a splint and a painkiller for under $300, and see your doctor when you can.

But more recently these clinics have evolved to offer a wider range of services. Have an ear infection or strep throat, and you're likely to walk out with a bill under $100, probably $60 or $70 and some basic medication. And that sports physical my friend spent $85 for is only $40. When you have a few minutes to spare, do a Google search on "urgent care" or "emergency medical treatment," with your city or town in the search. You might be surprised at what you'll find, and visiting a few before you need to or talking to others is a good idea.

Alternative No. 2: A clinic in Aisle 3
In-store medical clinics are the most recent and fastest growing trend. These clinics, as the name implies, are located in highly trafficked stores, like drug stores, groceries and even a few Wal-Marts and Targets.

They're staffed not by full medical doctors but by licensed nurse practitioners and physician's assistants. They treat a wide range of maladies, including sore throats, ear and eye infections, female bladder infections, skin infections and rashes, and offer vaccinations. One of the largest, MinuteClinic, with facilities in 23 states mostly in the Midwest and East, advertises a 10-minute wait and "most" services between $49 and $59. And they're open during store hours. So dealing with the son's skin rash costs $59, not $115 at the traditional physician, as my friend also found out.

MinuteClinic, owned by drugstore operator CVS Caremark (CVS) plans to double its locations to 400 in 2007, and, according to CEO Michael Howe, has long-term plans for 2,500 facilities in CVS pharmacies alone.

With other operators including RediClinic and QuickCare also expanding from a regional to a national stage, these clinics may someday be as easy to find as a Starbucks.

Well, maybe not quite. But while basic health care will remain more expensive than a double latte, it may soon be almost as convenient. And it may be cheaper than you think.