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

Allen, Lindsay (2017)
Dissertation (76 pages)
Committee Chair / Thesis Advisers: Hockenberry, Jason Michael; Cummings, Janet
Committee Members: Pitts, Stephen R
Research Fields: Public health; Economics
Keywords: Urgent Care Centers; Retail Clinics; Access; Emergency Department; Medicaid
Program: Laney Graduate School, Health Services Research and Health Policy
Permanent url: http://pid.emory.edu/ark:/25593/s29v9

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

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 ..................................................................................................

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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