Urgent Care Centers: Good for Patients, Bad for Real Healthcare Reform
Experts agree that the key to solving our healthcare crisis is rebuilding primary care. Advocates of the "patient-centered medical home" maintain that our system would deliver higher quality care at lower cost if primary-care doctors better coordinated their patients' care. Yet in the real world, patients have a hard time getting in to see their primary-care physicians. So we have the phenomenon of the urgent-care center, which caters to patients who want to be seen right away but don't have a problem that's serious enough for them to go the emergency room.
There are now 8,700 urgent-care centers in the U.S., up from 8,100 in 2007. Once derided as "doc-in-the-boxes," they have now spread across the country. For many patients, they are the main place to go for care -- especially on weekends or evenings when their primary-care physicians don't have office hours. Only 29 percent of U.S. primary care doctors even have after-hours coverage, far less than their counterparts in Europe.
Urgent-care centers are a boon for patients in other ways. The wait time to see a provider is typically half an hour or less, compared to a multi-hour wait time in many emergency departments. And patients can often see a doctor, as opposed to a nurse practitioner if they go to a retail clinic. Moreover, urgent-care centers offer imaging and other services not found in retail outlets.
Employers, insurers and other payers also benefit from urgent-care centers, which charge only a fraction of what an ER visit would cost. And employees can get back to work sooner instead of spending half the day in the ER. Overall, a 2009 RAND Corp. study reported, 14 to 27 percent of ER visits could be handled by urgent-care centers or retail clinics, saving up to $4.4 billion a year in health costs.
There's a nascent movement to franchise urgent-care centers, which could be the next big growth area in health care. When 32 million more people get health coverage and start looking for primary care in 2014, it's a good bet that many of them will go to urgent-care centers.
So what's not to like?
Urgent-care centers are a symptom, not a cause of the fragmentation that afflicts our system. Yet their expansion will worsen that fragmentation and work against the coordination of care. When a patient goes to an urgent-care center, it's unlikely that they'll see the same provider twice in a row. The physician or nurse who examines them knows nothing about their medical history, and their primary-care doctor is unlikely to hear about their visit to the urgent-care center. So once again, medical information is falling into a black hole, never to be discovered again.
The only thing that can be done is to restructure the whole crazy non-system so that it begins to resemble a system for care coordination. But that's unlikely to happen if more people stay away from their primary care doctors. Welcome to U.S. health care.
Image supplied courtesy of Wikimedia Commons.
for more features.