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

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

About this Dissertation

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School	Laney Graduate School
Department	Health Services Research and Health Policy
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health Economics, General
Parola chiave	Access Medicaid Urgent Care Centers Emergency Department Retail Clinics
Committee Chair / Thesis Advisor	Cummings, Janet, Emory University Hockenberry, Jason Michael, Emory University
Committee Members	Pitts, Stephen R, Emory University

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