Frustrated by runaway health costs, America'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.
Within the past two years, companies including Toyota, Sprint Nextel, Florida Power & Light, Credit Suisse and Pepsi Bottling Group have opened or expanded on-site clinics. Many employers are adding or planning to add even more clinics, which were experimented with about 30 years ago but fell out of favor amid questions about their cost-effectiveness.
Today a new wave of clinics is opening, driven largely by a motive that was less of a factor in the past: employers' desires to reduce their health insurance premiums by taking care of workers before they need to see outside doctors. More than 100 of the nation's 1,000 largest employers offer on-site primary care or preventive health services - a number forecast to exceed 250 by the end of the year, according to David Beech, a health benefits consultant.
Corporate America's in-house medical offices go well beyond traditional occupational health clinics that hundreds of factories have long maintained for job-related injuries and workers' compensation cases. Employees can stop by for checkups, allergy and flu shots, pregnancy tests or routine monitoring for chronic diseases such as diabetes and asthma.
When prescription drugs are required, some employers arrange for the pills to be delivered the next day at the office or plant, while others maintain fully stocked pharmacies.
Even at the older-style clinics run by companies such as General Motors, about 40 percent of the services now rendered "could be characterized as primary care or urgent care," said Dr. Joel Bender, corporate medical director of GM Health Services. But at these more traditional clinics, employees are typically sent on to their family physician or an outside specialist.
At the newer corporate health centers, by contrast, the goal whenever possible is to help solve the employees' health problems without the need for additional outside care.
Such clinics have been attempted in the past, reaching a peak in the 1970s and then gradually being eliminated as redundant. In the past few years, though, as health insurance premiums have soared and many companies have run up big bills at emergency rooms and urgent care centers, the corporate clinic has made a comeback.
For employees, on-site clinics can mean faster medical attention and lower out-of-pocket costs, because visits are usually free or carry only a small co-payment. Some workers might fret about the privacy of their medical records, but employers say they treat the information carefully and responsibly. Some companies hire outside providers to run the clinics, thus offering an additional privacy firewall.
For employers, on-site clinics can mean gains in worker productivity and lower health-insurance outlays. "A clinic serving a couple thousand employees can probably save $1.5 million to $2 million a year," said Beech, a health care specialist at the Watson Wyatt benefits consulting firm. "Right away, it's easy to see reduced referrals to hospital emergency rooms and specialist physicians, and a shift away from hospital outpatient doctors to the clinic."
The biggest primary care clinic to date opened Jan. 2 in Texas, when Toyota workers and their families started using a $9 million, 20,000-square-foot medical center alongside a new truck assembly plant in San Antonio.
Unlike most of the new medical offices - which are staffed by nurse practitioners and in some cases by a part-time doctor - Toyota's San Antonio health center has two-full time doctors, a part-time physician, a blood-test lab and an X-ray center.
And yet, even smaller operations, like the one with nurses, a physician's assistant and a part-time doctor at the midtown Manhattan offices of the investment firm Credit Suisse, are drawing praise from many employees.
John Probert, a 42-year-old Credit Suisse foreign-exchange trader, recently took a few minutes from his 10 1/2 -hour work day to pick up a prescription for a throat remedy at the firm's clinic. He had it filled at a nearby pharmacy.
"My throat was just killing me," Probert said. The next day one of the clinic's two nurses, Allison Ain, called to see how he was faring. "I told her I was feeling much better," he said. "It's nice to have a human on the other end of the phone that actually cares."
And he liked the fact that his medical care did not take much of his time. "Instead of doing it on a Saturday," Probert said, "you can just hop over next door and get back on the trading floor."
Pepsi Bottling, another sponsor of clinics, is trying to meet the basic health care needs of its 33,000 workers at 46 plants and 264 distribution centers around the country. The company has 15 clinics and plans to open 15 more over the next couple of years, according to David Kasiarz, the vice president for compensation and benefits.