The Impact of Urgent Care Centers and Retail Clinics on Health CareAccess and Emergency Department Use Open Access

Allen, Lindsay (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/wd375x16b?locale=en
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Abstract

Urgent care centers and retail clinics - collectively referred to as walk-in clinics - represent a large, rapidly growing sector of the health care delivery landscape. These clinics are purported to improve access to health care and reduce non-emergent emergency department (ED) visits, yet empirical evidence about their impact on these outcomes is notably lacking. This dissertation provides foundational evidence about 1) the community characteristics associated with walk-in clinic locations; 2) the percentage of ED visits that could be transferred to walk-in clinics; and 3) the impact of walk-in clinics on rates of non-emergent ED use. Special attention is paid to the role of insurance, including Medicaid. Overall, I find that urgent care center and retail clinics are unlikely to have as large an impact on these outcomes as is hoped. First, walk-in clinics are not located in areas where health care access is most limited. Second, the percentage of ED visits that could be shifted to walk-in clinics is limited by access to the clinics themselves. Finally, walk-in clinics do not appear to reduce non-emergent ED use. For walk-in clinics to improve meaningfully health care access or ED use, policy makers should invest in additional research about this industry.

Table of Contents

CHAPTER 1: INTRODUCTION........................................................... 1

The Walk-in Clinic Market .................................................................2

Conceptual Framework ......................................................................3

Appropriateness .................................................................................3

Availability .........................................................................................4

Accommodation .................................................................................5

Affordability .......................................................................................5

Acceptability.......................................................................................6

The Emerging Role of Walk-in Clinics................................................6

Exhibit 1: Conceptual Framework......................................................8

CHAPTER 2: ZIP CODE LEVEL FACTORS ASSOCIATED WITH URGENT CARE CENTER AND RETAIL CLINIC LOCATIONS ......9

INTRODUCTION ...............................................................................9

METHODS ........................................................................................12

Data ..................................................................................................12

Measures and Analysis .....................................................................13

Limitations .......................................................................................14

RESULTS ...........................................................................................15

Urgent Care Centers ..........................................................................15

Retail Clinics .....................................................................................16

DISCUSSION .....................................................................................17

Exhibit 1: Map of Urgent Care Location and Retail Clinics in United States ......21

Exhibit 2: Characteristics of Non-Rural ZCTAs with and without Urgent Care Centers and Retail Clinics ......22

Exhibit 3: Marginal Effect of ZCTA-Level Characteristics on Probability of Having an Urgent Care Clinic in Non-Rural ZCTA ......23

Exhibit 4: Marginal Effect of ZCTA-Level Characteristics on Probability of Having a Retail Clinic in Non-Rural ZCTA ......24

Exhibit 5: Direction of Omitted Variable Bias .....................................25

CHAPTER 3: HOW MANY NON-EMERGENT EMERGENCY DEPARTMENT VISITS COULD BE MANAGED AT WALK-IN CLINICS? ......26

INTRODUCTION .................................................................................26

METHODS ...........................................................................................27

Data .....................................................................................................27

Analytic Strategy..................................................................................29

RESULTS ..............................................................................................31

DISCUSSION ........................................................................................32

Exhibit 1: Sample NYU ED Algorithm Probabilities ............................35

Exhibit 2: Percentage of ED Visits Treatable at Walk-In Clinics, by Payer Status ......36

CHAPTER 4: THE IMPACT OF URGENT CARE CENTERS AND RETAIL CLINICS ON NON-EMERGENT EMERGENCY DEPARTMENT USE ......37

INTRODUCTION ..................................................................................37

METHODS ............................................................................................40

The Role of Insurance...........................................................................41

Data ......................................................................................................42

Methodology and Measures ..................................................................42

Limitations ...........................................................................................45

RESULTS ...............................................................................................46

DISCUSSION .........................................................................................48

Exhibit 1: Payer Mix for ED and urgent care center visits .....................50

Exhibit 2: Analytic Sample Derivation ..................................................51

Exhibit 3: Marginal Effect of Walk-in Clinic Closures on Non-Emergent ED Visit Rate ......52

Exhibit 4: Hourly rate of non-emergent ED visits per ZIP code for those with private insurance, without an urgent care center in ZIP ......53

APPENDIX.............................................................................................54

Appendix A:Last Closure Time of Walk-in Clinic ..................................54

Appendix B: Marginal Effect of Walk-in Clinic Closures on Non-Emergent ED Visit Rate, 9 PM and 7 PM ......55

Appendix C: Marginal Effect of Walk-in Clinic Closures on Non-Emergent ED Visit Rate, Various Time Windows ......56

CHAPTER 5: CONCLUSION...................................................................57

REFERENCES.........................................................................................58

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