Although patients still have to pay for prescriptions, people who lose their jobs and health insurance after March 31 will be able to get free treatment at Walgreen stores with Take Care clinics for conditions such as respiratory problems, allergies, infections and skin conditions, among other ailments.  These treatments typically cost $59 or more for people with no insurance.

According to Hal Rosenbluth, chairman of the Take Care Health Systems division, the plan is an experiment; he isn’t certain how patients will respond to the program or what it will cost the company.  What’s certain is that the move is likely to generate positive attention for the clinics.  The typical Take Care patient tells eight other people about the experience, so the move could bring in significant new paying customers.  Walgreen’s operates 341 Take Care clinics in 35 markets around the country, including Chicago, Atlanta, Miami and Cleveland.

To receive free treatment, patients must present proof that they have lost their jobs, including a federal or state unemployment determination letter and an unemployment check stub.  They will be required to sign a form stating that they have lost their jobs and health benefits.

Although the economy is shedding jobs at an alarming rate, the healthcare industry added 371,600 jobs during 2008.  That momentum has not slowed, despite the fiscal crisis and recession.  While the economy lost 1.9 million jobs during the fourth quarter of 2008, healthcare added 93,200 jobs.  Hospitals hired 11,900 new workers in December, bringing the nation’s total hospital workforce up to approximately 4.71 million.  Physicians’ offices hired 5,600 more staff, bringing that workforce up to nearly 2.3 million employees.

Ambulatory-care centers saw 1,100 jobs vanish during December, a 0.2 percent loss.  Still, that fast-growing sector grew to 521,700 jobs during all of 2008, a 1.7 percent increase compared with the previous year.

“The only major private industry sector that continued to add a significant number of jobs was healthcare”, notes Keith Hall, commissioner of the Bureau of Labor Statistics.

According to a new Ernst & Young study on business risk, the global war for talent will be top of the mind for CEOs.  Nowhere will this be more evident than in healthcare.  There remains a chronic shortage of surgeons and family-practice doctors.  Part of this is because U.S. medical schools held enrollment to 16,000 students a year from 1980 to 2005, fearing a glut of doctors under managed care.  Perhaps the hiring by hospitals is a correction to 25 years of no-growth within certain specialties and the continuing dearth of nurses.

At present, 46 million American citizens lack healthcare insurance.  And, as unemployment rates rise, people who lose their insurance stop seeing their physicians and taking needed medications.

President Barack Obama has made a significant start by proposing a $634 billion healthcare reserve fund that will be partially paid for with targeted cuts in payments to insurers, physicians, hospitals, drug manufacturers, other providers and wealthy senior citizens.  According to White House aides, Obama’s intent is to dole out the pain gradually to minimize opposition.  All of these stakeholders were well-represented at the recent White House Healthcare Forum and will be a part of the ongoing dialogue.

The suggested $634 million is only a down payment.  True healthcare reform is likely to cost at least $1 trillion, with half coming from reduced Medicare and Medicaid payments to doctors, hospitals and other providers.  The remaining funds will come from the government’s reduction of tax breaks on wealthy couples earning upwards of $250,000.

the economy lost 651,000 jobs during February, healthcare added 27,000 new positions.

In terms of the construction of new facilities during 2009, healthcare development is expected to fall by five or eight percent.  Yet, the drivers that historically have made the healthcare market so strong - obsolescence, new technologies and demographics - are still very much in place.

The collapse of the $330 billion auction rate securities market which let healthcare systems borrow money long term while paying short-term interest rates - cut off a principal source of capital for new development.  Hospitals have investment portfolios tied to Wall Street, another source of capital that is being cut off.  Endowments are drying up as even the most dependable philanthropists see their fortunes shrink.  Access to long-term debt vehicles, such as variable-rate demand bonds backed by letters of credit, is available only to healthcare systems that are A-rated or even better.  Even when a provider has superior credit, interest rates to borrow money may be as high as six to 6.5 percent.  For some hospitals and healthcare providers, the cost of credit - if they can get it - is too expensive.

To fill the gap, healthcare providers are considering private sources that have the capital necessary to finance projects.  The upside of private capital is that it can be committed over the long term to help hospitals and providers fulfill their strategic expansion plans without the same balance sheet implications - something hospitals are focused on in order to maintain a good standing with the ratings agencies.

In a 0 percent federal rate environment when 30-year fixed-rate mortgages have come down to 5.29 percent, capital is competitive with traditional hospital financing, compared with other cycles.

The doctor deficit has its roots in the 1980s and 1990s when medical schools capped their enrollments at 16,000 students per year because they believed that managed care would create a physician glut.  The exact opposite has happened and medical schools were “woefully wrong” in their assessment, according to Josef Fischer, chairman of surgery at Beth Israel Deaconess Medical Center in Boston.  “It’s going to be tough in this situation to make it better.”

Accordingly, medical educators have identified the problem and are finally accepting more applicants.  During 2008, nearly 17,800 students started medical school — the largest class ever.  By 2015, medical schools hope to achieve a 30 percent increase in enrollment over 2002 levels.  Still, Fischer warns of “a perfect storm” forming, because it takes three to seven years to train physicians at a time when the number of senior citizens in the United States is growing fast.  With training for surgeons often exceeding seven years and few pre-med students focused on primary care as a career, additional enrollments are only a first step in the right direction.

Many doctors would prefer a career in primary medicine, focused on prevention and health, but the reality of medicine in today’s environment is that reimbursement for physician services is decreasing.  The healthcare system itself is discouraging the very best and brightest talent from pursuing primary care.  Fixing what is broken in the system at a time when prevention should be more important than ever requires fast action if we are to meet our needs in the next decade.