A New Health Care Vision for New York City's Workforce

More than 65 years ago, New York City began providing affordable healthcare to its workforce through free clinics for members of the city's health plan. It was an idea ahead of its time -- and now is the moment to bring it back.

Right now, the city spends $6.3 billion each year on health insurance for 300,000 city employees, their families, and almost 200,000 retirees. In five years, that amount is expected to increase by 30 percent to $8.3 billion. Unchecked, this trend will ultimately bankrupt us. With this much at stake, it's imperative that the city and its workers reduce costs.

One proven way to do this: worksite health care clinics that provide workers and their families with primary care like routine check-ups, basic lab tests, prescriptions, vaccines, and chronic disease management. Nationally, today, almost one-third of large employers offer clinics at or near their worksites. Here in New York, private-sector organizations like the Freelancers Union and the New York Hotel & Motel Trades Council have rolled out large-scale primary care clinics for their members, with promising results.

Clinics like these save money in many ways. Salaried doctors order fewer expensive tests. People with chronic conditions like diabetes can easily schedule appointments to better manage their disease. Access to convenient clinics reduces absenteeism and increases productivity. And regular check-ups increase participation in wellness routines like better diet, exercise, and smoking cessation.

The savings are substantial. Research shows that on-site or conveniently accessible clinics can save $1.60 to $4 for every dollar invested. Private employers with on-site clinics report savings of 4 percent to 12 percent on their healthcare costs. Local governments across the country have reported direct healthcare plan savings of as high as 18 percent from a clinic initiative.

At the low end, 4 percent savings would add up to $150 million per year of direct healthcare costs at full implementation, in addition to the "soft savings" associated with fewer sick days taken and better productivity from a healthier workforce.

I am proposing the creation of up to 20 high-quality, user-friendly clinics to service the City's large and diverse workforce. These clinics would be located at or near municipal workplaces. We have the expertise: New York City is already a large-scale healthcare provider, providing care to more than one million New Yorkers each year through hospitals, treatment centers, and school-based clinics.

The city can encourage its workers to use these low-cost clinics by making them convenient and accessible, offering a wide array of services for no co-pay, or allowing workers to visit without using sick-leave time.

The first health plans offered to city employees -- pioneered by Mayor LaGuardia almost 70 years ago -- were based on a similar model of clinic-based primary care. Over the decades, the clinics fell into disrepair and out of favor -- dismissed as second-class care. But in 2013, consumers are welcoming friendly, modern clinics as a convenient place to get primary care.

The responsible way to manage health costs is to find new ways to get more for each health care dollar -- seeking better and more convenient care. Our City's fiscal health, and the health of our workforce and their families, hangs in the balance.