There’s also a question of whether efficiency in actual provider care would be welcome. “Many of us would be happy to get cheaper drugs, but are we going to be happy to get a cheaper doctor?” Caplan said. “A lot of people don’t want an efficient doctor who takes five minutes. They want someone who listens to them and knows them. It may be harder in the world of efficiency to get the same doctor.”
Then there are ethical issues. “Will business ethics tamp down medical ethics?” Caplan said. “Just because you’re good at shipping rugs within 48 hours doesn’t mean you’re going to be able to take care of people’s health.”
One little-known source of high healthcare costs is nonprescription equipment and supplies. With Amazon closely tied to providers, your doctor may be able to put in a request on your account for crutches, Donovan said, not to mention wheelchairs, splints, tongue depressors, thermometers, hearing aids, and syringes.
This could raise conflicts of interest, Caplan said. Amazon may give you a discount on its thermometer and not tell you about the other nine. It’s a healthcare consumer’s right to know all the options, he said.
One area where Amazon undisputedly excels is its user interface. Let’s face it, it has made buying very, very easy. This ease and simplicity could extend to the healthcare realm, which, right now, is a rat’s maze,” Donovan said.
Convenience is a huge part of Amazon’s brand, Farr said, adding that this could make it easier to get medications by mail, a growing business.
Thanks to Amazon’s lead in virtually everything, it’s in a good position to expand upon One Medical’s telehealth options, Caplan said. Retail healthcare already trades on convenience for people who need the option to meet with doctors from home.
“It’s particularly hard to get an in-person appointment quickly with a primary care provider,” Caplan said. “I could see Amazon building up something like nurses to help you with advice, faster access to a pharmacist if you have a question. They could even have people answering questions who aren’t in this country, although that would raise legal issues.”
Probably the major concern here is privacy. If you get a prescription for the diabetes drug metformin, will you then start getting ads for glucose monitors or sugar-free candy? If you’re prescribed statins, what if you start seeing ads for treadmills?
“This is a company that mines data as a core part of its business,” Caplan said. “Privacy is not one of the things that Amazon has fully committed to with sensitive healthcare information.”
Farr is less concerned about medical privacy. “It would be a massive, massive deal if they violated HIPAA,” she said. “I’m much more concerned about consumer health information. There are far fewer laws protecting that information, like using a wearable device to track your period.”
Amazon’s HIPAA policy, which is posted online, “is very standard in a good way,” Donovan said. An Amazon spokesperson said, “Should the deal close, One Medical customers’ HIPAA Protected Health Information will be handled separately from all other Amazon businesses, as required by law.”
Amazon Pharmacy and primary care ventures have the potential to equalize healthcare, but they could also accomplish the opposite. “Some people are not going to be able to access this world because they’re not internet and computer savvy,” Caplan said. “It could introduce a new form of healthcare disparity and inequity. You’re either too old or you’re rural or you may not have a computer because you’re poor. Amazon doesn’t serve everybody.”
Meanwhile, retail healthcare providers like CVS, Walgreens, and Rite Aid tend to cluster in affluent, urban centers like New York, San Francisco, and Seattle, Farr said.
And expect to see more of the same as other companies expand their healthcare presence. CVS Health has already partnered with insurance giant Aetna. “There may be entries by other big internet-slash-social media companies into this space,” Caplan said. “I couldn’t predict who but maybe Google, Facebook.”