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.