Table of Contents
ONE: EXECUTIVE SUMMARY
Scope and Methodology
The U.S. Healthcare Market
The Emergence of Retail Clinics
TWO: INTRODUCTION
The U.S. Healthcare System Today
Overview
The Need for Alternatives
High Cost of Care
Inconsistent Quality of Care
Delays to Treatment
Healthcare Reform
Medical Tourism
The History of Retail Clinics
Retail Clinics Today
Business Model
Consumer Response
Growth Drivers
Challenges
Kalorama Survey on Consumer Retail Clinic Feedback
Establishing a Retail Clinic
Demographics and Location
Choice of Outlet
Systems and Scheduling
Funding and Expansion
Alliances
THREE: OUT-OF-POCKET EXPENDITURES: THE MARKET IN 2015
Types of Expenditures
Insurance Co-Payments
Direct Payments
Premiums and Plan Fees
Payment Methods
Cash or Check
Credit Cards
Loans and Lines of Credit
Flexible Spending Accounts
Health Savings Accounts
Medical Financing
Amount Financed
Elective Procedures
Non-Elective Procedures and Prescription Drugs
Non-Elective Procedures and Prescription Drugs
Consumers Who Pay Out-of-pocket
The Uninsured and Underinsured
Medicaid Recipients
Persons with Chronic Conditions
FOUR: OUT-OF-POCKET EXPENDITURES: THE MARKET IN 2014 – 2019
Trends
Out-of-pocket Expenditure Growth Drivers
Out-of-Pocket Expenditure Growth Constraints
Forecasts
Expenditures by Type
Payment Methods
Amount Financed
Types of Expenses Financed
Consumers Who Pay Out of Pocket
FIVE: RETAIL CLINIC SERVICE PROVIDERS
The Industry
Convenience Clinic Sales Forecasts
The Market
Competitive Positions of Key Players
SIX: RETAIL CLINIC SUPPLIERS
Point of Care Tests
The Industry
Competitive Positions of Key Players
Convenience Clinic Sales Forecasts
Clinical Chemistry and Immunoassays
The Industry
Competitive Positions of Key Players
Convenience Clinic Sales Forecasts
Vaccines
The Industry
Competitive Positions of Key Players
Convenience Clinic Sales Forecasts
SEVEN: OUTLETS FOR RETAIL CLINICS
Drug Stores
The Industry
Competitive Positions of Key Players
Other Medical Care
Food Stores
The Industry
Competitive Positions of Key Players
Other Medical Care
Convenience Clinic Sales Forecasts
Mass Merchandisers
The Industry
Competitive Positions of Key Players
Other Medical Care
Convenience Clinic Sales Forecasts
Other Outlets
The Industry
Competitive Positions of Key Players
Other Medical Care
Convenience Clinic Sales Forecasts
EIGHT: TOTAL MARKET
Retail Clinic Sales
Sales of Suppliers
Indirect Revenue
NINE: ISSUES AND TRENDS
Health Care Reform
Public Awareness
Competition with Primary Care Providers
Regulation
Overview
Regulation of Convenience Clinics
Pending Legislation
Development of Standards
Streamlining of Services
Physician Shortages
Labor Shortages
TEN: COMPANY PROFILES
Access Health
History and Lines of Business
Financial Information
Convenience Clinics
Aurora Quick Care
History and Lines of Business
Financial Information
Convenience Clinics
Bellin Health FastCare
History and Lines of Business
Financial Information
Convenience Clinics
Capital One Healthcare Finance
History and Lines of Business
Financial Information
Patient Financing
CareCredit
History and Lines of Business
Financial Information
Patient Financing
CareSpot
History and Lines of Business
Financial Information
Convenience Clinics
Clear Balance
History and Lines of Business
Financial Information
Patient Financing
Credit Medical
History and Lines of Business
Financial Information
Patient Financing
e-Financing Solutions
History and Lines of Business
Financial Information
Patient Financing
The Little Clinic
History and Lines of Business
Financial Information
Convenience Clinics
MedChoice Financial
History and Lines of Business
Financial Information
Patient Financing
MinuteClinic
History and Lines of Business
Financial Information
Convenience Clinics
RediClinic
History and Lines of Business
Financial Information
Convenience Clinics
Reliance Medical Finance
History and Lines of Business
Financial Information
Patient Financing
Target Clinic Medical Associates
History and Lines of Business
Financial Information
Convenience Clinics
Walgreens
History and Lines of Business
Financial Information
Convenience Clinics
APPENDIX: CONSUMER OPINION
U.S. Adults: Have You Visited a Retail Clinic?
LIST OF EXHIBITS
TWO: INTRODUCTION
Figure 2-1: Distribution of Health Plan Enrollment for Covered Workers by Plan Type, 1988 – 2014 (Conventional, HMO, PPO, POS, HDHP/SO)
Figure 2-2: National Health Expenditures (NHE) and NHE as a Percent of GDP, 1980 – 2015
Figure 2-3: Average Annual Health Insurance Premiums and Worker Contributions for Family Coverage, 2004 – 2014
Figure 2-4: Unnecessary Deaths Resulting from Variations in Health Care Quality, by Condition (Diabetes Care, Prenatal Care, Smoking Cessation, Beta Blocker Treatment, Breast Cancer Screening, Cholesterol Management, Colorectal Cancer Screening, Controlling High Blood Pressure)
Table 2-1: U.S. Health Care Coverage of the Non Elderly, 2013
Table 2-2: Cost Savings from Medical Tourism for Various Procedures, 2014
Table 2-3: Scope of Practice Laws for Non-Physician Medical Practitioners
Table 2-4: Estimated Number of U.S. Convenience Clinics, 2009 – 2019
Table 2-5: Characteristics of Retail Outlets, 2014
Table 2-6: Benefits and Drawbacks of Convenience Clinic Funding Approaches, 2015
THREE: OUT-OF-POCKET EXPENDITURES: THE MARKET IN 2015
Figure 3-1: Premium Increases vs. Increases in Workers Earnings and Prices, 2000 – 2014
Figure 3-2: Consumer Out-of-pocket Health Care Expenditures, 2014 (Co-pays, Direct Payments, Premiums)
Figure 3-3: Consumer Out-of-pocket Health Care Expenditures by Payment Type, 2014(HSAs, Health Care Financing Programs, Loans or Lines of Credit, FSAs, Credit Cards, Cash or Check)
Table 3-1: Main Business Activities of Selected Medical Financing Companies, 2014(Financing Elective Procedures, Financing Non-Elective Procedures, Non-Medical Consumer Credit)
Figure 3-4: Average Out-of-Pocket Payment by U.S. Residents with Health Care Spending by Percentile of Total Health Spending, 2014 (Cosmetic Surgery, Cosmetic Dentistry, Eye Procedures, Chiropractic Services, Hair Restoration, Fertility Treatments, Weight Loss Surgery, Other)
Figure 3-5: Methods of Financing Elective Procedures, 2014 (Loans or Lines of Credit, Cash or Check, Health Care Financing Programs, Credit Cards)
Figure 3-6: Average Share Paid Out-of-Pocket by U.S. Residents with Health Care Spending by Type of Service, 2014 (Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Home Health, Vision, Other Health Care)
Figure 3-7: Average Share Paid Out-of-pocket by U.S. Residents with Health Care
Spending by Percentile of Total Health Spending and Type of Service, 2014 (Hospital,
Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Home
Health, Vision, Other Health Care)
Figure 3-8: Distribution of Out-of-pocket Spending on Non-Elective Procedures for the Average Person, 2014 (Prescription Drugs, Emergency Room, Dental, Vision, Other Health Care, Hospital, Outpatient, Office Based Visit)
Figure 3-9: Distribution of Out-of-pocket Spending for the Average Person, by Spending Level, 2014 (Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Home Health, Vision, Other Health Care)
Figure 3-10: Drug Cost Coverage by Payor Type (Public, Private, Cash): 1965, 1986, 2000, 2005, 2010, 2015
Table 3-2: Obesity in the United States, 1980 – 2019
Figure 3-11: Proportion of Adults under Age 65 with Chronic Conditions, 2014(Privately Insured, Medicare or Medicaid, Uninsured, Other)
FOUR: OUT-OF-POCKET EXPENDITURES: THE MARKET IN 2014 – 2019
Table 4-1: Selected Rx-to-OTC Switches in the United States, 1990 – 2014
Table 4-2: Consumer Out-of-pocket Expenditures per Worker, 2009–2019
Table 4-3: Consumer Out-of-pocket Expenditures by Type, 2009–2019
Figure 4-1: Proportion of Consumer Out-of-pocket Spending by Type of Health Care Expenditure, 2009, 2014, 2019 (Direct Payments, Co-pays, Premiums)
Table 4-4: Consumer Out-of-pocket Expenditures by Type, 2009–2019
Figure 4-2: Proportion of Consumer Out-of-pocket Spending by Payment Type, 2009, 2014, 2019 (Credit Cards, FSAs, Health Care Financing Programs, Cash or Check, Loans or Lines of Credit, HSAs)
Table 4-5: Amount of Consumer Out-of-pocket Expenditures for Elective Procedures That Are Financed, 2009–2019
Table 4-6: Amount of Consumer Out-of-pocket Expenditures for Non-Elective Procedures That Are Financed, 2009–2019
Figure 4-3: Proportion of Consumer Out-of-Pocket Spending for Elective Procedures That Is Financed (All Methods), 2014 – 2019 (Cosmetic Surgery, Cosmetic Dentistry, Eye Procedures, Chiropractic Services, Hair Restoration, Fertility Treatments, Weight Loss Surgery)
Figure 4-4: Distribution of Out-of-pocket Spending on Non-Elective Procedures for the Average Person, 2014, 2019 (Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Vision, Other Health Care)
Figure 4-5: Proportion of Consumer Out-of-pocket Spending for Non-Elective Procedures That is Financed (All Methods), 2014 – 2019 (Hospital, Outpatient, Office Based Visit, Prescription Drugs, Emergency Room, Dental, Home Health, Vision)
Table 4-7: Size of High Risk Groups for High Out-of-Pocket Health Care Expenditures, 2009–2019 (Uninsured and Underinsured, Medicaid Recipients, The Disabled, Senior Citizens, The Mentally Ill, The Obese, Persons with Chronic Conditions)
FIVE: RETAIL CLINIC SERVICE PROVIDERS
Table 5-1: The U.S. Market for Retail Clinic Services, 2009–2019 (Number of Clinics by Year End, Patients/Clinic/Day, Revenue per Patient, Total)
Figure 5-1: Growth of U.S. Retail Clinic Services, 2009–2019 (Number of Clinics, Revenues)
Table 5-2: Leading Service Providers’ Revenues and Market Share, U.S. Market for Convenience Clinics, 2014
Figure 5-2: Market Shares of Leading Retail Clinic Service Providers, 2014
SIX: RETAIL CLINIC SUPPLIERS
Table 6-1: Sales to Retail Clinics by Supplier Segment, 2009–2019 (POC Tests, Clinical Chemistry and Immunoassays, Vaccines, Total)
Figure 6-1: Growth of Retail Clinic Supplier Sales by Type of Supplier, 2009–2019(POC Tests, Other Tests, Vaccinations)
Table 6-2: U.S. Professional POC Test Sales, 2009–2019
Table 6-3: Leading POC Test Makers’ U.S. Revenues and Market Share, 2014
Table 6-4: U.S. Professional POC Test Sales to Retail Clinics, 2009–2019
Table 6-5: U.S. Professional POC Test Sales to Retail Clinics by Segment, 2009–2019(Cholesterol Tests, Diabetes Tests, Strep, Influenza & Pneumonia Tests, Other Tests,
Total POC Tests)
Table 6-6: U.S. Clinical Chemistry and Immunoassay Sales, 2009–2019
Table 6-7: Leading Clinical Chemistry and Immunoassay Suppliers’ Revenues andMarket Share, 2014
Table 6-8: U.S. Clinical Chemistry and Immunoassay Sales to Convenience Clinics,2009–2019
Table 6-9: U.S. Clinical Chemistry and Immunoassay Sales to Convenience Clinics, by Segment, 2009–2019 (Tests for Strep, Tests for TB, Other Tests, Total Tests)
Table 6-10: Diseases for Which Vaccines Are Available in the U.S., 2015
Table 6-11: U.S. Market for Preventative Vaccines, 2009–2019 (Adult Vaccines,Pediatric Vaccines, Total, Percent Change)
Table 6-12: Leading Vaccine Manufacturers’ U.S. Revenues and Market Share, 2014
Table 6-13: U.S. Vaccine Sales to Convenience Clinics, 2009–2019
Table 6-14: U.S. Vaccine Sales to Convenience Clinics, by Segment, 2009–2019 (Flu,HPV, MMR, Td/Tdap, Other Vaccines, Total)
SEVEN: OUTLETS FOR RETAIL CLINICS
Table 7-1: Number of Retail Clinics by Type of Retail Outlet, 2004–2019 (Drug Stores, Supermarkets, Mass Outlets, Other, Total)
Figure 7-1: Proportion of Retail Clinics by Type of Retail Outlet, 2009–2019 (Drug Stores, Food Stores, Mass Outlets, Other)
Table 7-2: Rents Collected From Retail Clinics by Type of Retail Outlet 2009–2019(Drug Stores, Supermarkets, Mass Outlets, Other, Total)
Figure 7-2: Proportion of Rents Collected From Retail Clinics by Type of Retail Outlet 2009–2019 (Drug Stores, Food Stores, Mass Outlets, Other)
Table 7-3: Indirect Income Generated by Retail Clinics by Type of Retail Outlet,2009–2019 (Drug Stores, Supermarkets, Mass Outlets, Other, Total)
Figure 7-3: Proportion of Indirect Income Generated by Retail Clinics by Type of Retail Outlet, 2009–2019 (Drug Stores, Food Stores, Mass Outlets, Other)
Table 7-4: Selected Retail Outlet Relationships with Convenience Clinics, 2015 (Type, Number of U.S. Locations, Clinic Partners)
Table 7-5: U.S. Drug Store Sales, 2009–2019
Table 7-6: Leading U.S. Drug Stores’ Revenues and Market Share, 2014
Table 7-7: U.S. Drug Store Direct Retail Clinic Revenues, 2009–2019(Number of Stores, Square Footage, Cost per Square Foot, Total Rents)
Table 7-8: U.S. Drug Store Indirect Retail Clinic Revenues, 2009–2019 (Number of Clinics, Patients/Clinic/Day, Incremental Sales per Patient, Total Indirect Revenue)
Figure 7-4: Direct vs. Indirect Revenues to Drug Stores from Retail Clinics, 2009–2019(Total Indirect Revenue, Total Results)
Table 7-9: U.S. Food Store Sales, 2009–2019
Table 7-10: Leading Food Stores Revenues and Market Share, 2014
Table 7-11: U.S. Food Stores Direct Retail Clinic Revenues, 2009–2019 (Number of Stores, Square Foot/Store, Cost/Square Foot, Total Rents)
Table 7-12: U.S. Food Store Indirect Retail Clinic Revenues, 2009–2019 (Number of Clinics,Patients/Clinic/Day, Incremental Sales per Patient, Total Indirect Revenue)
Figure 7-5: Direct vs. Indirect Revenues to Food Stores from Retail Clinics, 2009–2019(Total Indirect Revenue, Total Rents)
Table 7-13: U.S. Mass Merchandiser Retail Sales, 2009–2019
Table 7-14: Leading U.S. Mass Merchandisers Retail Revenues and Market Share,2014
Table 7-15: U.S. Mass Merchandiser Direct Retail Clinic Revenues, 2009–2019(Number of Stores, Square Foot/Store, Cost/Square Foot, Total Rents)
Table 7-16: U.S. Mass Merchandiser Indirect Retail Clinic Revenues, 2009–2019(Number of Clinics, Patients/Clinic/Day, Incremental Sales per Patient, Total
Indirect Revenue)
Figure 7-6: Direct vs. Indirect Revenues to Mass Merchandisers from Retail Clinics,2009–2019 (Total Indirect Revenue, Total Rents)
Table 7-17: U.S. Other Retail Sales, 2009–2019
Table 7-18: Leading Other Outlets Revenues and Market Share, 2014
Table 7-19: U.S. Other Outlets Direct Retail Clinic Revenues, 2009–2019(Number of Stores, Square Foot/Store, Cost/Square Foot, Total Rents)
Table 7-20: U.S. Other Outlets Indirect Retail Clinic Revenues, 2009–2019(Number of Clinics, Patients/Clinic/Day, Incremental Sales per Patient, Total Indirect Revenue)
Figure 7-7: Direct vs. Indirect Revenues to Other Outlets from Retail Clinics, 2009–2019(Total Indirect Revenue, Total Rents)
EIGHT: TOTAL MARKET
Table 8-1: Retail Clinic Service Revenues, 2009–2019
Table 8-2: Sales to Retail Clinics by Suppliers, 2009–2019
Table 8-3: Revenues to Retailers from In-Store Clinics, 2009–2019 (Indirect Revenues,
Direct Revenues, Total)
Figure 8-1: Revenues to Retailers from In-Store Clinics, 2009–2019(Indirect Income, Direct Income)
NINE: ISSUES AND TRENDS
Table 9-1: Selected U.S. Federal and State Health Care Oversight Bodies, 2015
Table 9-2: Retail Clinic Legislation by State, 2015
APPENDIX: CONSUMER OPINION
Table A-1: Survey Question Results of U.S. Adults Who Indicated Yes(I Have Visited a Retail Clinic)
