I'm not sure what Aetna brings to the table in regard to a future where nurses fill CVSes, either. That seems like it would be a far bigger operation than buying Aetna, and the two would be only tangentially related.
Buying Aetna makes it easier to expand the new Minute Clinic business model. CVS no longer has to worry about getting paid less than a hospital for treating a cough or fever. Aetna could even charge zero copay for nurse visits. It's more competition in the "basic healthcare" space (if it happens).
Amazon is going to buy drugs in major bulk (Walmart, or Mail-order-pharmacy style), and likely will charge low "dispensing fees" (because robots will do most thigs). CVS is looking to be the "other other Walmart" of pharmacies. I have worked (as an intern) in many pharmacies, and I've seen several buyouts. At this point in time, I'm very happy that I made the leap from PharmD to SRE/DevOps about 11 years ago. Pharmacists will be robots in <5 years IMHO.
All pharmacies, electronic and brick-and-mortar, go through one of 3 wholesalers: Cardinal, AmerisourceBergen, or Mckesson. It's, "which retailer can drive distribution?"
We both agreed it would never have been so easy in the states.
Hospitals do this too. In some cases 2-3 pharmacists can cover 10-12 hospitals for off shift dispensing needs.
With the black horse cavalry running the country, we’re going to see lots of M&A activity like this.
The problem with these mergers is they allow health plans that further disadvantage other pharmacies or providers. Once those other options are eliminated we’ll see prices rise. Do people actually want the Home Depot’s of healthcare rather than the equivalent of the local hardware store? We’ll see I guess.
Evidence suggests that they've used their monopoly to artificially inflate prices quite dramatically.
A brick and mortar pharmacy must have a pharmacist on-site to dispense drugs. Not only are they supposed to do a final check on prescriptions filled, but they must be available for patient question and sometimes medicine requires advice from a pharmacist before it can be dispensed. In addition, there are some stricter laws for certain controlled medications and these checks must be done by a pharmacist. If the pharmacist gets sick or in a car accident on the way to work, the pharmacy can't legally open (they can section the pharmacy off with its own locks to keep the convenience store open).
In my experience, that's already the situation. Actually, reality is worse. The rich (meaning, upper middle class and not sick) get full care and even excessive care, while the poor get basic or no care, often emergency only.
If you go to a hospital for an emergency procedure, the level of care and follow up care depends on your insurance. When the hospital thinks they probably won't be paid for services they choose to not offer them. So, the poor get basic care... while rich people get full care.
It's now a system where wealthy, government employees, and the poor (i.e. subsidized) have access to full care, and most of the middle class just goes without.
In the past 5 years, I've gone from a decent $20 copay to a employer-sponsored high deductible to currently a fully out of pocket deductible of $2k before insurance pays a cent.
I've begun rationing my prescriptions and simply skip the doctor unless it's a true life-or-death situation.
The deductible for co-workers with a kid or two is something like $5k. That's on top of probably $10k in premiums a year.
I sometimes think that's one of the things that's kept health care so expensive. Nursing salaries aren't cheap. A lot of the home health and basic clinic stuff could be handled by an LPN/LVN or even a Paramedic in many cases. Not everything needs an RN. There are plenty of available telemedicine options to put a provider in touch with a higher level of care if necessary.
If you've ever had to attend something like Physical Therapy, you'll see the actual PT (a MS/Doctorate level professional aka DPT) about twice. Once for an eval, and once for a discharge. An "aide" will guide you through all the other exercises, and they make very significantly less than a PT.
The savings are mysteriously gone, even adding lower-salaried professional extenders.
This needs the caveat of “to American consumers”. The NHS seem to be heavily moving in that direction, and I suspect “cheaper” is no small part of that
https://www.cvs.com/minuteclinic/why-choose-us/our-practitio...
To expand their services to all of their stores, they'd be looking at hiring 5 or 10 percent of the NPs and PAs in the country.
The minimum requirements of a RN is an Associates degree and successful completion of the NCLEX -- though, many hospitals require a person to also obtain a BSN after a few years to continue being employed. That's a big educational jump to make.
I don't think pay is a big motivator for nurses. There are so many better paying jobs out there that are easier to get, and don't involve dealing with the figurative and literal shit nurses deal with daily.
While we might cost about the same, our scope of practice is a lot broader than an LPN's...
Nursing unions and trade groups are generally very opposed to the 'paramedic practicioner' or 'community paramedicine' model.
More competition in healthcare could be a good thing--many say it's bloated and overpriced. The risk is that poor people get basic care while rich people get full care, widening health disparities.
It's unclear what the new healthcare economics will look like. Currently, minor procedures are profit centers for doctor's offices and hospitals. They subsidize complicated patients (often elderly with multiple chronic diseases like diabetes or COPD) who are riskier and take more time to treat. If CVS is taking that money, then hospitals may need to do some cost-cutting.