Supply of Medical Services

Does the arrival of urgent care centers reduce the acuity of visits at nearby EDs?

Urgent care centers are on the rise. Back in 2013, there were only 6,100, but this number increased to 9,616 by late 2019 a 7.9% average annual increase. The rise of urgent care could have positive or negative impacts on overall health care spending. On the one hand, increased supply could lead to higher cost if individuals begin to use urgent care over primary care visits; on the other hand, if people with less serious acute conditions begin visiting urgent care centers rather than the emergency department (ED), then cost could fall.

A paper by Allen et al. (2021) aims to answer whether the rise of urgent care did affect the composition of visits at nearby EDs. The authors link data from a urgent care center database with the Healthcare Cost and Utilization Project’s State Emergency Department Databases (SEDD) from six states. The authors use a difference-in-difference approach examining how ZIP code‐level changes in the acuity mix of ED visits changed when nearby urgent care centers were open versus closed. Using this approach, the authors found that:

…having an open urgent care center in a ZIP code reduced the total number of ED visits by residents in that ZIP code by 17.2% (P < 0.05), due largely to decreases in visits for less emergent conditions. This effect was concentrated among visits to EDs with the longest wait times. We found that urgent care centers reduced the total number of uninsured and Medicaid visits to the ED by 21% (P < 0.05) and 29.1% (P < 0.05), respectively.

The authors measured ED visit acuity was based on the NYU ED algorithm (for more details see here and here). The authors note that while urgent care centers do appear to be taking some of the less severe cases from ED centers, the net impact on cost was not examined. Also, it is not clear if urgent care centers are siphoning off the relatively easier, more profitable cases from EDs; this could have an overall positive effect on health care spending but could be harmful for ED finances.

An interesting study covering an area of increasing importance with the number of urgent care centers rising.


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