Understanding the Relationship between Retail Clinics and Primary Care Infrastructure Open Access

Warlick, Andrew James (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/44558f01z?locale=en
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Abstract


Abstract

Understanding the Relationship between Retail Clinics and Primary Care
Infrastructure
By Andrew James Warlick
The rapid increase in retail medicine over the past 5 years has caught many off guard. Between 2006 and 2007, the number of retail clinics increased more than two-fold from 441 to 982 nationwide, but has leveled off since 2008. Yet little is known about the determinants of where these health facilities are built. Existing research has only looked at basic demographic characteristics and rarely in a multivariate context. This study expands on existing research by using new data sources to conduct multivariate analyses that examine the associations among area-level socio-demographic characteristics, primary health care infrastructure, and the location of retail clinics. Using data from the 2006 Dartmouth Health Atlas, this thesis assesses the impact that the number of primary care physicians and the number of federally qualified health centers had on the presence and number of retail clinics in a defined geographic area, after adjusting for population characteristics. After conducting a multi-stage two step model, we found that retail clinics are more likely to locate in areas that have higher numbers of primary care providers and more federally qualified health centers (FQHCs). Also, we found that the number of federally qualified health centers is positively associated with having multiple retail clinics in a given area. These findings suggest that retail clinics are using federally qualified health centers as a marker for identifying potential markets to enter.

Table of Contents



Table of Contents

Introduction................................................................................................................... 1

Literature Review.......................................................................................................... 3

Cost and Quality Research ........................................................................................ 3

Retail Clinic Location ............................................................................................... 4

Conceptual Framework ............................................................................................. 9

Population Characteristics....................................................................................... 10

Income & Insurance............................................................................................ 10

Population Age.................................................................................................... 11

Racial Composition............................................................................................. 11

Healthcare System Factors ...................................................................................... 12

Number of Primary Care Providers .................................................................... 12

Federally Qualified Health Centers .................................................................... 13

Conclusion............................................................................................................... 14

Methods....................................................................................................................... 15

Data ......................................................................................................................... 15

Study Sample ...................................................................................................... 15

Dependent Variables ............................................................................................... 16

Explanatory Variables ............................................................................................. 16

Demographics ..................................................................................................... 16

Key Variables of Interest .................................................................................... 17

Analytic Sample.................................................................................................. 17

Analysis................................................................................................................... 18

Results........................................................................................................................ 21

Descriptive Statistics ............................................................................................... 21

Bivariate Analyses................................................................................................... 21

Multivariate Analyses ............................................................................................. 23

Discussion................................................................................................................... 33

Comparing Key Findings to the Existing Literature ............................................... 33

Expanding the Literature......................................................................................... 35

Policy Implications.................................................................................................. 37

Limitations .............................................................................................................. 38

Future Research and Data Needs ............................................................................ 39

Conclusion .................................................................................................................. 41

Appendix A: Full Models with State Fixed Effects.................................................... 42

Appendix B: Sample PCSA Development.............................................................. 44

Bibliography ............................................................................................................... 45

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