Urgent care centers are growing across the United States in response to emergency rooms that are standing-room-only for many patients trying to access them. But can urgent care centers play a cost-effective, high quality part in stemming health care costs and inappropriate use of ERs for primary care.

That’s a question asked and answered by The Surge in Urgent Care Centers: Emergency Department Alternative or Costly Convenience? from the Center for Studying Health System Change by Tracy Yee  et. al.

The Research Brief defines urgent care centers (UCCs) as sites that provide care on a walk-in basis, typically during regular business hours, as well as evenigns and weekends, though not 24 hours a day. They treat the kinds of conditions seen in primary care offices and retail clinics – ear infections, strep throat, the flu, and minor injuries, among the most common treatments seen at UCCs.

UCCs are generally found in high-density, high-income areas with heavy foot and vehicle traffic and high proportions of employer-sponsored health care among the people who live in the local communities. UCCs are lower-cost than than emergency rooms, and roughly equal in cost to primary care practices. UCCs’ patients tend to be privately or Medicare-insured. When UCCs serve uninsured people, they generally require up-front payment which, as Yee and her colleagues point out, can be a barrier to access.

When owned and operated by hospital groups, UCCs provide convenient continuity of care within their health systems. One hospital executive quoted in the paper referred to urgent care as a “funnel” or “gateway” to their hospital system.

Health Populi’s Hot Points:  The expansion of insured people in the U.S. in 2014 is expected to strain the already-constrained primary care supply of doctors and other primary care providers (PCPs). UCCs can be viewed as convenient, community-based sources for primary care – although they are staffed by PCPs which diverts those staff people away from more traditional primary care locations (doctors’ offices, ERs, clinics, etc..

But if the cost structure of the UCC is lower, and quality assured, then UCCs can play a key role as an on-ramp to primary care before patients seek care in a more expensive emergency department.

The challenge will be in educating people who currently prefer using the emergency department to seeing physicians in offices to using lower cost sites like UCCs. This will be a critical challenge especially for lower-income people: in research published this week in Health Affairs, the case is made for Understanding Why Patients of Low Socioeconomic Status Prefer Hospitals Over Ambulatory Care. Kangovi et. al. found that patients with low socioeconomic status use more acute hospital care and less primary care than patients with high socioeconomic status.

This pattern of care conflicts with goals toward moving people toward a high-value health system, to channeling people to access health care services in the most appropriate level and cost of care. If lower-income people tend to perceive high-value and quality is gained in the hospital setting, all things being equal, that pattern won’t change unless incentives (payment, personal values, social network pressures) do.

Kangovi and colleagues warn that accountable care organizations shouldn’t assume that patient-centered medical home strategies will automatically be attractive to newly-insured patients. As in all new product designs, the key to success is in building the values and preferences of customers into the offering. Patients have a stake and must play a role in crowdsourcing the design of a more effective U.S. health system.