Despite heightened employer interest in workplace clinics as a cost-containment tool, only 4 percent of American families in 2010 reported visiting a workplace clinic in the previous yearthe same proportion as in 2007, according to a national study by the Center for Studying Health System Change (HSC). The severe 2007-09 recession likely dampened employer investment in workplace clinics, and some workers likely lost access to clinics because of job layoffs. Workplace clinics are concentrated among large, self-insured employers, so only a subset of families has access to these resources. Among families most likely to have accessthose with ties to large firms and government employersclinic use was higher at nearly 11 percent in 2010. Most experts believe workplace clinics can best achieve cost savings through better prevention and early diagnosis of chronic conditions. However, the study found that among clinic users, the most commonly sought services were vaccinations and other minor, routine services. Nearly seven in 10 people cited convenience as a major reason for choosing a workplace clinic over other care settings, and four in 10 cited lower costs. Workplace clinics are typically only viable for large employers with low employee turnover and high concentrations of workers, which means they are unlikely to provide a broad solution for controlling health care spending or improving care delivery.
- Despite Employer Interest, Workplace Clinic Use Low
- Recession Fallout on Workplace Clinics
- Clinic Use Varies by Industry
- Most Visits for Minor, Routine Care
- Convenience and Cost Key to Clinic Use
- Usual Source of Care and Workplace Clinic Use
- Data Source
Despite Employer Interest, Workplace Clinic Use Low
What distinguishes many emerging workplace clinics is a shift toward primary care, preventive services and wellness offerings.1 By incorporating these services, employers hope to generate savings on overall medical costs. In the short term, a key employer objective is to exert greater control over high-cost services, such as specialist referrals, brand-name prescriptions, emergency department visits and avoidable hospitalizations. In the long run, improving population health by preventing and managing chronic conditions is a major objective.2
Findings from recent employer surveys confirm that employer interest has increased, as the share of large employers reporting plans to implement an onsite clinic over the next two years doubled between 2007 and 2011, from 6 percent to 12 percent.3 Moreover, the number and size of vendors specializing in operating onsite clinics have grown in recent years.4
Despite evidence of high interest among large employers, use of workplace clinics remains low. In 2010, only 4 percent of all American families reported having at least one member who used a workplace clinic in the previous year, according to findings from HSC’s nationally representative 2010 Health Tracking Household Survey (see Data Source). This estimate was unchanged from 2007 (see Table 1).
The low use is not surprising, given that only a subset of Americans has access to workplace clinics. To better reflect that only some families have access to workplace clinics, this study focused on the subset of families with at least one working-age adult, aged 18-64, employed by a private firm with at least 1,000 workers or by a government employer. After narrowing the analysis to this subgroup, nearly 11 percent of such families in 2010 reported visiting a workplace clinic during the past yearroughly the same proportion as in 2007.
Recession Fallout on Workplace Clinics
Also, financial pressures caused some employers to delay or cancel plans to open clinics and other employers with existing clinics to scale down or even shutter their clinics.8 Several employer surveys confirm that the prevalence of workplace clinics among large employers remained unchanged (at about 25%) over this period.9
Clinic Use Varies by Industry
More than 11 percent of families with workers in public administration and a similar share of families with ties to the services sector used a clinic in the past year. At the other end of the spectrum were families employed in the transportation or public utilities sector (3.4%) or in wholesale or retail trade (3.4%).
Most Visits for Minor, Routine Care
Even as employers focused on primary care and wellness offerings in workplace clinics in recent years, the services most often sought by clinic users were for minor, routine care (see Table 2). When asked the primary purpose of their clinic visits, 63.7 percent of survey respondents in 2010 cited vaccinationsby far the highest prevalence for any clinic service. From 2007 to 2010, the proportion of people citing vaccinations increased by 15.1 percentage pointsa surge in demand that may be related to the 2009 H1N1 influenza pandemic.11 This phenomenon was not limited to workplace clinics and reflects a more general trend of rising vaccination rates during this period that also impacted other care settings, such as retail clinics.12
Despite widespread employer recognition of the importance of ongoing chronic care, use of workplace clinics for this purpose appears limited. Fewer than one in 10 clinic users in 2010 cited ongoing care of chronic conditions as the primary purpose for their visits—unchanged from 2007 and far lower than the prevalence of chronic conditions in the workforces of most employers.13
Two important caveats should be noted about these results. First, a single family member answered questions about clinic use and reasons for visits on behalf of all family members, which may impact reliability. Moreover, because the survey asked clinic users only for the primary purpose of their most recent visit, estimates may not capture the full extent of the care patients received.
Previous research has shown that, in workplace clinics providing primary care and wellness services, clinicians typically use any clinic visitincluding those for minor, routine careas an opportunity to address broader aspects of a patient’s health.14 For instance, employees who go to a clinic with a sprained ankle or a sore throat would undergo blood pressure checks and other screenings at a minimum. Consequently, services such as vaccinations, physical examscited by 31 percent of clinic usersor treatment of new illnesses or symptomscited by 26 percentall can provide opportunities for clinicians to identify health issues beyond the primary reason for the visit.
Convenience and Cost Key to Clinic Use
Affordability also was a major concern among clinic users. Nearly four in 10 clinic users cited lower cost as motivation for choosing a workplace clinic over another source of care. This aligns with indications that employers may offer financial incentives to encourage clinic use.15 Often, employers will structure their benefits so that out-of-pocket cost sharing for clinic visits is lower than for community-based visitsfor instance, $10- or $15-dollar differentials in required copayments are common among employers looking to incentivize workplace clinic use. Sometimes, cost sharing is waived altogether for clinic visits. As some employers shift toward higher out-of-pocket cost sharing for employees, clinics may become even more appealing in these cases.
Usual Source of Care and Workplace Clinic Use
In 2010, families with a usual source of care were significantly more likely to have used a clinic in the previous year compared to families without a usual source of care12.2 percent vs. 7.5 percent (findings not shown). One possible explanation is that people with a usual source of care may be more connected to the health system and more aware of available resources. Or, they may have more health care needs and, therefore, seek more services across multiple settings. Another possibility is that some respondents might consider the workplace clinic itself to be their usual source of care, though this is likely to impact only a small number of cases.
Even as more employers implement workplace clinics, their reach is largely limited to employees of large firms with low turnover and highly concentrated workforces. Therefore, while clinics may be valuable tools for controlling costs and improving care for some segments of the population, they are not likely to provide a broad solution to rising costs. Nevertheless, clinics may have some potential to serve as testing grounds for innovations in care delivery and coordination that could have impacts beyond individual employers.
1. According to a recent employer survey, in 2010, 15 percent of employers with at least 500 employees had primary care clinics onsiteup from 11 percent in 2009and another 10 percent were considering establishing such clinics over the next two years. See Hess, Corrinne, “Insurance Company Planning Clinics,” The Business Journal, Milwaukee, Wis. (May 20, 2011).
2. Tu, Ha T., Ellyn R. Boukus and Genna R. Cohen, Workplace Clinics: A Sign of Growing Employer Interest in Wellness, Research Brief No. 17, Center for Studying Health System Change, Washington, D.C. (December 2010).
3. Towers Watson, New York, N.Y., and National Business Group on Health, Washington, D.C., Shaping Health Care Strategy in a Post-Reform Environment: 16th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care (March 2011); Watson Wyatt, New York, N.Y., and National Business Group on Health, Washington, D.C., Dashboard for Success: How Best Performers Do It: 12th Annual National Business Group on Health/Watson Wyatt Survey Report (February 2007).
4. Tanweer, Anissa, “More Firms Opening On-site Clinics,” Arizona Daily Star (Jan. 1, 2012).
5. In December 2007, the national unemployment rate was 5.0 percent. At the end of the recession, in June 2009, it was 9.5 percent. The unemployment rate peaked at 10.0 percent in October 2009. See U.S. Bureau of Labor Statistics, BLS Spotlight on Statistics: The Recession of 2007-2009, Washington, D.C. (February 2012).
6. Moscarini, Giuseppe, and Fabien Postel-Vinay, Large Employers are More Cyclically Sensitive, Working Paper No. 14740, National Bureau of Economic Research, Cambridge, Mass. (February 2009).
7. Eight of the top 25 so-called “layoff kings” had onsite clinics providing primary care at some point during 2007-2010. Another three offered occupational health services onsite and one had a clinic devoted to wellness. See McIntyre, Douglas, “The Layoff Kings: The 25 Companies Responsible for 700,000 Lost Jobs,” Daily Finance (Aug. 18, 2010).
8. Vesely, Rebecca, “On- and Near-site Clinic Slowdown Could Hurt Access: AAFP President,” Modern Physician (Jan. 12, 2009).
9. About a quarter of employers with at least 1,000 workers reported having a workplace clinic each year from 2007-2011. See Towers Watson/National Business Group on Health (2011); and Watson Wyatt/National Business Group on Health (2007).
10. Edington, Dee W., Zero Trends: Health As a Serious Economic Strategy, University of Michigan Health Management Research Center, Ann Arbor, Mich. (2009).
11. McNeil, Donald G., Jr., “Nation is Facing Vaccine Shortage for Seasonal Flu,” The New York Times (Nov. 4, 2009).
12. Centers for Disease Control and Prevention, Final Estimates for 2009-10 Seasonal Influenza and Influenza A (H1N1) 2009 Monovalent Vaccination CoverageUnited States, August 2009 through May 2010; and Uscher-Pines, Lori, et al., “Growth of Retail Clinics in Vaccination Delivery in the U.S.,” American Journal of Preventive Medicine, Vol. 43, No. 1 (July 2012).
13. Edington (2009).
14. Tu, et al. (2010).
15. Tu, et al. (2010).
This Research Brief presents findings from the Center for Studying Health System Change 2007 and 2010 Health Tracking Household Surveys. Both surveys use nationally representative samples of the civilian, noninstitutionalized population. For the first time, the 2010 survey included a cell phone sample because of declining percentages of households with landline phones. Sample sizes included about 18,000 people for the 2007 and about 17,000 people for the 2010 survey. Response rates for the surveys were 43 percent in 2007 and 46 and 29 percent, respectively, for the landline and cell phone samples in 2010. Population weights adjust for probability of selection and differences in nonresponse based on age, sex, race or ethnicity, and education. The weights adjust also for the increased probability of selection in cases of households using both landline and cell phones. The 2007 and 2010 surveys were based on a stratified random sample of the nation. Standard errors account for the complex sample design of the surveys. Questionnaire design, survey administration and the question wording of all measures in this study were similar across surveys.
For each surveyed family, the primary family respondent was asked: “Have you [or names of other family members] ever used an onsite health clinic at your or [Spouse’s] workplace?” Respondents who answered yes were then asked: “Have you [or names of other family members] used an onsite health clinic at a workplace during the past 12 months?” Respondents who answered yes to this question were then asked about services obtained during clinic visits and reasons for choosing workplace clinics over other care settings.
All estimates reported in this study are family-level, not person-level, estimates, because respondents were not asked which family members received workplace clinic services. Most estimates presented in this study were based on the subset of families with at least one working-age adult, aged 18-64, employed by a private firm with at least 1,000 workers or by a government employer. Sample sizes for this subset of families with workplace clinic visits in the past year were 260 in 2007 and 259 in 2010. Individual characteristicssuch as having a usual source of care and industry typewere ascribed to the family based on the member who was identified as the most likely to have access to workplace clinici.e., the working-age adult employed by a large firm or a government employer.