MILFORD, Del. — As companies try to rein in rising healthcare costs, workers in many industries are dealing with on-site health clinics. Large employers including Toyota Motor Corp., Pepsi Bottling Group, Credit Suisse and Sprint Nextel have set up or expanded on-site health clinics in recent years.

Workers aren't forced to use these company clinics, but companies provide financial incentives including lower co-pays, deductibles and an ability to see the on-site doctor on company time.

But some workers and their advocates say the centers present a potential conflict. The same doctors taking care of the workers' private, ongoing medical needs may be in charge of treating them for work-related injuries, as is the case at Salisbury, Md.-based Perdue Farms.

"Some individuals may think it is too paternalistic," said Pat Schoeni, executive director of the National Coalition on Health Care in Washington, D.C.

An estimated 23 percent of large employers — those with at least 1,000 employees — have on-site health clinics, according to a 2006-2007 survey by the human resource consulting firm Watson Wyatt Worldwide. Another 6 percent of these large employers plan to add clinics next year.

Perdue is considered a pioneer in succeeding to slash healthcare costs by building on-site health clinics. By taking charge of administering and managing its own health plan, Perdue's healthcare costs have been declining. The average cost per worker was 3 percent lower during fiscal year 2007, which ended March 31, compared with fiscal year 2004. Nationwide, the cost of employer-sponsored health plans rose an average of 8 percent in 2006.

"It's an issue of corporate will, not technical ability," said Dr. Roger Merrill, chief medical officer at Perdue. "Companies don't want to be in the medical business. My answer to that is you are already in the medical business if you are spending millions of dollars in medical bills."

CLINIC HISTORY

On-site health clinics are not new. In the late 1930s and 1940s, large industrial manufacturers such as Kaiser established healthcare clinics for their construction, shipyard and steel mill workers. The system was working so well, in 1945 the company opened its health centers to the public, eventually giving rise to one of the largest health management organizations in the United States, Kaiser Permanente.

Until the 1970s, many large manufacturers established on-site medical clinics to treat workers with injuries, and some provided preventive care services. But these clinics disappeared because companies viewed them as costly. This time around, companies view these clinics not just as treatment centers for injured workers, but also as preventive care centers.

"The convenience would be great, but I think a lot of the employees would worry about the confidentiality," said Schoeni. "There is so much discrimination health-wise against certain diseases, against any type of depression or mental health problem. Employees don't want their employers to know they are being treated for depression or alcoholism or drug addictions."

Health information of workers using on-site health clinics may be protected by a privacy rule under the Health Insurance Portability and Accountability Act of 1996, or HIPPA, which establishes privacy standards for healthcare providers and health plans. Under that rule, healthcare providers and plans generally can't share health information with employers without patients' permission.

However, in order to be covered by HIPPA, a clinic would have to process health insurance claims, and many do not, said Joy Pritts, a lawyer and research associate professor at Health Policy Institute at Georgetown University.

PRIMARY CARE SOURCE

Like at most U.S. poultry processing plants, immigrants are the backbone of Perdue's workforce. Many of these workers don't speak English, have very little formal education — even in Spanish — and often don't have a primary care physician. About 80 percent of the workers at Perdue use the clinics as their main source of primary care, Perdue officials said.

"It is positive because at least they offer immediate assistance on site, and the patients will not have to miss work to go to the doctor if it is a minor problem," said Dr. Fabricio Alarcon, medical director of La Red Health Center, a federally funded community-based health provider assisting Hispanics in Georgetown.

Some workers question whether the doctors and nurses have their best interest in mind or simply want to prescribe a quick fix and make them go back to work. Many view these doctors as "company docs."

Pedro Vasquez, 28, a former bodyguard in Guatemala who now works in the distribution center of the Georgetown plant, said his hand has been bothering him, but he doesn't have much confidence in the Wellness Center to treat him.

"It's always the same," he said. "A pill and back to your work again."

Ultimately, it is the worker's decision, said Julie DeYoung, spokeswoman for Perdue.

"If they would be unsafe either to themselves or others, we would of course send them home," DeYoung said. "Even if we say, 'Go back to work,' and the person feels like they don't want to go back to work, we don't force them. It's their decision to go back to work."