Column: Proliferation of urgent care clinics in Hawaii is worrisome

The progressive proliferation of urgent care facilities in Hawaii is a worrisome sign. Certainly, urgent care has a role in treating nonemergent health care issues after hours and for visitors, but, increasingly, these facilities have become a last resort for access to care. The people of Hawaii are better served by strong, sustainable relationships with primary care providers. Nothing can replace the benefits of a patient- centered medical home that can prevent and treat what ails.

Given the high cost of a visit to the emergency department compared with urgent care, pragmatic insurance carriers are keen to pay less for the same services. However, they also understand that this bodes poorly for the global quality and cost of health care. In comparison with both emergency physicians and primary care providers, urgent care providers often have less training, receive lower reimbursement and tend to be more transient. In addition, they are neither equipped for nor focused on a long-term clinical relationship with their patients. Each urgent care visit essentially starts from scratch with little background information, if any.

To be sure, urgent care facilities take pressure off of the emergency departments, which are overloaded by patients, the majority of whom do not present true emergencies.

One of the recent assaults to the Affordable Care Act (ACA), also known as Obamacare, is the removal of the health care mandate, which required all those eligible to secure health insurance or incur a tax penalty. This has caused an increase in premiums for those who do retain insurance coverage, but the unworried “well” still turn up for health care, but now with late-stage issues. The notion that “I am well because I feel well” is reasonable for most musculoskeletal problems. Degenerative disease of the spine, for example, does not need treatment if one is functional and pain-free. Other maladies such as diabetes, high blood pressure, high cholesterol and most cancers do not cause pain or dysfunction until a great deal of damage has been done.

A bonded relationship with a primary care medical provider, especially one who is embedded into a collaborative, multidisciplinary team, is best equipped to provide optimal outcomes. Attention to lifestyle, preventive screening as well as social and psychological issues stand to optimize quality of life and longevity. When serious medical issues arise, they can be found earlier and treated promptly, minimizing morbidity and mortality.

I worked part time in several urgent care facilities while Manakai o Malama Integrative Healthcare Group and Rehabilitation Center was in its early days, and witnessed the limitations they posed for immediate and long-term outcomes. Too often, deferred health care and avoidance of routine screening — particularly for breast, cervical, colon and prostate cancers as well as heart, kidney and liver disease — resulted in poor outcomes because diagnoses and treatment were rendered too late. I was struck that so many of these patients would dutifully maintain their homes, replacing a roof to prevent leaks, and bring their cars in for routine service but neglect their bodies.

Of course, an urgent care facility can be a welcome option for a urinary tract infection, a pediatric ear infection or a simple laceration on a Sunday afternoon, but these clinics should not be used to replace a trusting, longitudinal relationship with a team of providers familiar with you and your ohana.

The fact that urgent care centers are popping up all over the islands is a sign that these clinics are being used by those who have either poor access to health care or a poor understanding of the importance of a solid relationship with a primary care provider.

Dr. Ira Zunin is medical director of Manakai O Malama Integrative Healthcare Group and Rehabilitation Center. His column appears the first Saturday of every month. For more information, go to manakaiomalama.com. Submit your questions to info@manakaiomalama.com.