Who Goes to the Emergency Room Versus Urgent Care Centers, and Why? A Public Opinion Analysis

Abstract

Study Objective: There is increasing policy interest to redirect patients with low-acuity health needs away from the emergency department (ED) to potentially lower-cost alternatives such as urgent care (UC) centers. Few data exist regarding the patient’s perspective when making these decisions. We use a national public opinion survey to examine who uses the ED versus UC, their experiences with care at each facility in terms of quality and cost, and self-reported choices for choosing the ED versus an alternative among individuals with low-acuity health needs. Methods: This probability-based sample telephone survey was conducted in 2015 and includes a nationally-representative sample of 1,002 adults (age 18+) and a sample of 7,036 adults from seven states. We examined ED and UC utilization as well as experiences with care at these facilities in terms of quality and cost. We then focused on respondents who reported a low-acuity health need and tested associations of ED versus UC use across a variety of demographic and policy-relevant variables with a series of bivariate analyses and survey-weighted multivariable logistic regression modeling for both the national sample and combined 7-state sample. Given the larger sample size, we primarily report results from the combined 7-state sample and also summarize relevant differences when they occur with the national sample. Results: Approximately one-third of respondents in the combined 7-state sample reported using either the ED (32%) or UC (26%) in the past two years. Over 7 in 10 of users at both facilities reported satisfaction with the quality of care they received at those sites, but nearly 40% of ED users reported the cost of their care as unreasonable (as compared to 23% of UC users). Of those that used the ED, over half (54%) stated it was for a low-acuity health need. A plurality of low-acuity ED users (33%) report not having access to alternative sites of care as their main reason for using the ED. In the adjusted analysis, respondents who were unemployed, uninsured, and low-income were more likely to turn to the ED for a low-acuity visit compared to UCs. Conclusion: Americans commonly access both the ED and UC for self-reported low-acuity health problems, but these choices differ by socioeconomic profile. Future work should evaluate the barriers and facilitators to accessing potentially lower cost alternatives to the ED, particularly among vulnerable populations.