The Effect of Urgent Care Centers on Emergency Department Attendance and Waiting Times

Abstract

The timeliness of hospital Emergency Department (ED) care continues to deteriorate in manycountries around the world. Urgent care centers (UCCs) represent an alternative practice modelthat has recently been proposed and introduced in the state of Queensland, Australia, aimed atreducing non-urgent ED attendance. To examine the impact of this policy, we exploit the stag-gered opening of UCCs, studying their effects on ED attendance, waiting time to be seen, andnearby general practice attendance, using three modern difference-in-differences estimators anda generalized synthetic control method. We show that, while the number of ED presentationsdeclined, they did so for only one treatment cohort, for which presentation numbers pre-treatmenthad seen a different trajectory compared to the controls, and thus we cannot conclude the declinewas caused by the UCCs’ opening. We find that the UCCs did not improve the timeliness ofcare provided, nor reduce the rate of attendance at local general practices. However, we find astriking 32% increase in the total number of presentations across the ED and UCCs combined.Potential mechanisms may be the lower time-price for UCC care, exposing latent demand. Thesefindings have policy implications: when healthcare providers consider opening a UCC, the resultmay be a satisfaction of latent demand, rather than a reduction in ED attendance or waiting times.

Keywords: Emergency departments, urgent care centers, general practice, attendance, waiting time, difference-in-differences, Synthetic Control Method