Cents of Urgency: The Impact of a Collocated Urgent Care Center on Emergency Department Overuse

37 Pages Posted: 31 May 2023 Last revised: 7 Jun 2023

Date Written: May 31, 2023

Abstract

The potential of using urgent care centers (UCCs) to reduce emergency department (ED) overuse has gained increasing interest, but the effectiveness documented in the literature has been inconclusive. What determines the effectiveness of a UCC in reducing ED overuse requires rigorous investigation. In this paper, we focus on one factor: the relative location of UCC to the ED. Collaborating with a medical system and utilizing quasi-experimental settings, we estimate UCC effects using difference-in-differences models including staggered treatment adoption frameworks. We empirically show that when a UCC is collocated with an ED, it effectively reduces ED overuse. The collocated UCC absorbs 21.4% of ED low-acuity encounters, and 4.6% of ED mid-acuity encounters; these self-diverted patients further reduce the load on the ED test facilities. We then find empirical evidence of patients taking advantage of the collocation setup. In particular, patients may sample the ED queue and delay their facility choice when the UCC is collocated with the ED. We substantiate the benefits of collocation by contrasting the non-collocated UCC’s impact on ED overuse with the impact of the collocated UCC. We empirically show that a non-collocated UCC reduces ED low-acuity visits by an insignificant 13.1% and has no impact on the mid-acuity ED visits. That is, a collocated UCC diverts a larger amount and a higher acuity mix of patients from the ED compared to a non-collocated UCC. Such gaps in effectiveness do not attenuate over a long horizon. We hope to inform policy makers and practitioners that whether a UCC is collocated with an ED is one determinant of the UCC’s effectiveness in reducing ED overuse. While planning out new UCCs, the relative location of new UCCs to the existing EDs should be taken into consideration. We believe our results are timely and important amid the expansion of the UCC market.

Note:
Funding Information: None to declare.

Conflict of Interests: None to declare.

Ethical Approval: The data we are using are full masked, no personal information, and time-shifted secondary data.

Keywords: healthcare operations, emergency department overuse, collocation, capacity expansion

Suggested Citation

Li, Simin and Bassamboo, Achal and Lariviere, Martin, Cents of Urgency: The Impact of a Collocated Urgent Care Center on Emergency Department Overuse (May 31, 2023). Available at SSRN: https://ssrn.com/abstract=4222166 or http://dx.doi.org/10.2139/ssrn.4222166

Simin Li (Contact Author)

Tulane University - A.B. Freeman School of Business ( email )

7 McAlister Drive
New Orleans, LA 70118
United States

Achal Bassamboo

Northwestern University - Department of Managerial Economics and Decision Sciences (MEDS) ( email )

2001 Sheridan Road
Evanston, IL 60208
United States

Martin Lariviere

Northwestern University - Kellogg School of Management ( email )

2211 Campus Drive
Evanston, IL 60208
United States

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