Cents of Urgency: How Opening an Urgent Care Center Affects Emergency Department Arrivals?

The potential of using alternative facilities, including urgent care centers (UCCs), to reduce emergency department (ED) overuse has gained increasing interest, but the actual effectiveness is unclear. Whether patients would respond to a new UCC, and how patients would choose between an ED and a UCC, require rigorous investigation. In this paper, we partner with a major medical system and utilize a natural experiment setting to investigate how an ED is affected by the opening of a same-medical-system-affiliated and co-located UCC. The UCC serves less urgent patients only and does not offer follow-up care. The co-location and same-affiliation of the UCC and ED control for various unobserved patient preferences. We can therefore tease out how patients respond to facilities with different service capabilities using the difference-in-difference method. Comparing changes in patient arrivals pre- and post-UCC opening at the ED with a co-located UCC to changes in arrivals at EDs without co-located UCCs, we find the number of ED low-acuity encounters decreases by 20.9%, while the ED mid-acuity encounters decrease by 4.6%. We also find no change in the number of hospitalized ED mid-acuity encounters. Only low- to mid-acuity encounters requiring no follow- up care divert themselves, which indicates that patients are sophisticated enough to match their service requirements to facilities providing appropriate service capabilities. Patients diverting themselves from the ED trade off the full-range but unnecessary (for them) service capability at the ED for shorter waits and comparable quality of care at the UCC. This trade-off seems to rationalize and sustain patients’ self-diversion behavior in the long run. The self-streaming of patients induced by the opening of a cost-effective, limited- capability, and co-located UCC frees up the expensive and scarce ED resources for more severe encounters. A co-located UCC-ED system combined with informed patients could be a potential answer to overused EDs.