Healthcare Economics




Retail medicine could catch on in the Middle East
 




Already quite widespread in the West, retail medicine could be a lucrative prospect in the Middle East given the growing popularity of the shopping mall culture. Dr Mussaad Al-Razouki looks at this disruptive innovation and outlines its recent successes, failures and future trends in the US and the UK, with a view to implementing retail medicine in the GCC.


There is an interesting new trend sweeping the Western world; healthcare is moving away from hospitals and setting up shop in malls and other large retail outlets.

I was first introduced to the concept of retail medicine at the 2007 World Innovation Forum in New York City. Seen by many medical doctors as the scourge of traditional primary care, retail medicine has revolutionised the delivery of medicine through its own unique interpretation of disruptive innovation.

It all started on a wintry weekend in 1999, when American entrepreneur Rick Krieger took his sick son to an urgent care centre in Minneapolis, Minnesota. Rick knew his son needed his throat tested and soon enough, after a two-hour wait, a strep throat test was finally done.

Like many parents before him, Rick believed that there had to be a quicker, more convenient way for experienced parents and patients to get quick healthcare diagnoses, so he teamed up with a physician and a nurse to put the limits of traditional medicine to the test.

Convenience

Started as QuickMedx (and soon rebranded as the Minute Clinic), Krieger’s convenience care concept was simple – treat the 20% of disease that cause 80% of the visits to primary health centres (an essential extension of Paraeto’s 80/20 principle).

To keep costs down, Krieger and his team decided to staff these ‘mini clinics’ with resident nurses instead of physicians (pushing the boundaries of clinical practice) and locate the clinics within large retailers (thereby forgoing much of the costs such as building and servicing of restrooms).

Today, with over 500 clinics and close to two million mostly walk-in, cash-paying customers with a 99% satisfaction rate, the Minute Clinic (through its partnership with CVS Caremark Corporation) has opened up the US market to a whole new age of medicine. Even traditional medical power players such as the Mayo Clinic, have extended their brands into the retail medicine space, in this case via the Mayo Express Clinic.

More significant is box retailer Wal-Mart’s efforts, which started with a pilot programme in 2005 for 75 clinics in 12 US states and has since expanded to include plans for 6,600 medical clinics by 2012 through a partnership with various retail medicine companies such as RediClinic. Across the Atlantic, British supermarket giant J Sainsbury will also be adding government-paid doctors to some of its stores, where shopping patients will be alerted by a pager when their appointment arrives.

The ability now exists to put your next medical check-up on your grocery list.

The popularity of retail medicine lies in the trend of patient convenience. People want to have flexible visiting times. This is the millennium of multitasking and retail medicine is moving fast up the healthcare continuum as a complement to larger primary care clinics and hospitals.

In the UK, employees spend around 3.5 million working days a year travelling to and from doctors, costing the British economy close to $2 billion (estimated by the Confederation of British Industry). In the US, insurers have also advocated for increased healthcare options through retail medicine as evident by CIGNA Healthcare members in Dallas, Texas being offered convenience through the insurer’s addition of MedBasics Family Health Centers to its network.

Scepticism

However, the success of retail medicine is not without its share of scepticism. Many people and institutions (American Medical Association, American Academy of Pediatrics,) are concerned about quality of care, hygiene issues and the limited scope of the clinicians running these adhoc facilities. These issues, coupled with an inability to maintain the salaries of healthcare professionals, have forced retail medicine corporations such as CheckUps and Take Care Health Systems to shut down multiple walk-in clinics in both Wal-Mart and RiteAid respectively.

Industry experts estimate that a company can consume $300,000 to $600,000 to finance and maintain a retail clinic, breaking-even at about 25 to 30 patients a day. This should be no problem for retailers within the GCC, where the desert heat pushes the average consumer to frequent the mall over 70 times per year (according to Dubai-based market researcher GRMC).

GCC

The GCC retail industry is an extremely attractive sector globally, according to At Kearnery’s 10th annual Global Retail Development Index (GRDI) which ranks seven countries from the MENA region. Several countries in the region rank in the top 20 in the 2011 index of top ranked emerging markets for global retail expansion, including Kuwait (5th place internationally), Saudi Arabia (ranked 7th) and the UAE (ranked 9th).

With over five million square metres of retail space currently available in the GCC (worth over $100 billion and expected to treble in the next nine years according to Retail International), proprietors of retail medicine should have no problem carving out a niche for themselves with the right strategy and scope.

Developing a retail medicine concept specifically for the GCC would require significant investment and expertise. A number of detailed assessments need to be taken into account, starting with scope of service where the individual retail clinics must have a well-defined and limited scope of clinical services that falls within the local government regulations and is catered to local cultural norms. Also, an evidence-based medicine approach to clinical services and treatment must be implemented and quality improvement-oriented, in addition to the selection of the highly specialised staff.

Once the scope and staffing have been completed, an international partnership may be necessary to bring international best practices to the GCC.

The operations of the facility must be also carefully considered, with a team-based approach encouraged. Even retail walk-in clinics should have a formal connection with physician practices in the local community, preferably with family physicians, to provide continuity of care. Other health professionals, such as nurse practitioners, should only operate in accordance with local regulations, as part of a team-based approach to health care and under responsible supervision of a practicing, licensed physician.

Most importantly, a steady referral stream also needs to be established where the clinic must have a referral system to physician practices or to other entities appropriate to the patient’s symptoms beyond the clinic’s scope of work. The clinic should encourage all patients to have a “medical home”.

Finally, it is also essential to have electronic health records set up to gather and communicate the patient’s information with the local healthcare providers.

- Dr Mussaad Al-Razouki is the Chief Executive Officer at Kleos Healthcare Corporation, a Kuwaiti company that provides excellence in strategic planning and management for Middle East healthcare entities including investment companies, clinical service providers (i.e. hospitals), payors (i.e. insurance companies) and government regulatory bodies.

For more information, please visit: www.kleoshealth.com
 

 Date of upload: 21st Jan 2012

 

                                  
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