HCCI analysis has shown that spending on urgent care services among people with employer-sponsored insurance (ESI) increased by over 50% from 2018-2022, primarily due to a 34% increase in the use of urgent care over that period. For example, from 2019 to 2020, the use of urgent care increased 21%, from 99 visits per 1,000 people with ESI to 119 visits per 1,000 people. The following year, the use of urgent care grew an additional 31 percent, to 156 visits per 1,000 people. Respiratory related symptoms and illnesses were the main reason people with ESI sought urgent care from 2018 to 2022.
Using HCCI’s unique commercial claims dataset, we analyzed the diagnosis codes associated with the 73 million urgent care visits delivered between January 2018 and December 2022. We grouped those diagnoses into the following categories:
- Infectious Disease Exposure (vaccines, suspected exposure to infections, and STIs)
- Respiratory Symptoms and Infections (asthma, sinusitis, and the flu)
- COVID-19 diagnoses
- Pain and Injury (sprains, strains, fractures, and lower back pain)
- Other symptoms (fever, nausea, and vomiting)
- Other infections (ear infections, bacterial infections, and urinary tract infections)
For all but one month of our study period, respiratory-related diagnoses were the largest category of urgent care visits, suggesting that people are primarily using urgent care centers for respiratory ailments. That trend increased dramatically in 2020 continuing through 2022 and was largely responsible for the overall increase in use of urgent care services.
Figure 1 shows these diagnoses as a proportion of all urgent care visits, by month from January 2018 through December 2022.
From January 2018 to March 2020, Respiratory Symptoms and Infections made up 40% of all urgent care visits. This group of diagnoses ranged from 23% of urgent care visits in July 2019 to 54% in January 2018 and followed a seasonal pattern with visits increasing in the winter months and declining in the summer months.
In April 2020, Respiratory Symptoms and Infections declined while Infectious Disease Exposures began to increase. The Infectious Disease Exposures category consists of diagnosis codes such as contact with and (suspected) exposure to COVID-19, contact with and (suspected) exposure to other viral communicable diseases, and encounter for screening for COVID-19, with more than half of the category relating to contact and exposure to COVID-19. The most common symptom of COVID-19 is respiratory symptoms, similar to a cold or the flu.
From July 2020 through January 2022, the combination of Respiratory Symptoms and Infections, COVID Diagnosis, and Infectious Disease Exposures made up the vast majority (69%) of urgent care visit diagnoses, ranging from 50% in June 2021 to nearly 80% in December 2021. In that month, Infectious Disease Exposure made up 57% of urgent care visit diagnoses, COVID diagnoses made up 9%, and Respiratory Symptoms and Infections made up 14%.
From February 2022 through the end of our study period in December of 2022, these diagnosis categories still made up the majority of urgent care visits (53%) but substantially less than throughout 2021. In December 2022, the three categories accounted for 58% of urgent care visits.
In the 21 months following the onset of the COVID-19 pandemic, Infectious Disease Exposures made up most of the respiratory-related diagnoses. For example, in December 2020, Infectious Disease Exposure diagnoses made up 65% of urgent care visits while Respiratory Symptoms and Infections made up only 8% of visits. Beginning in February 2022, the percentage of Infectious Disease Exposure diagnoses decreased while the percentage of Respiratory Symptoms and Infections increased. By December of 2022, Respiratory Symptoms and Infections made up 35% of urgent care visits, Infectious Disease Exposure made up 18%, and COVID diagnoses made up 5%.
Despite the fluctuations over the five-year period we studied, respiratory-related diagnoses seem to have returned to their pre-pandemic levels. In December 2022, 58% of urgent care visits were for respiratory-related diagnoses, similar to the percentage of Respiratory Symptoms and Infection diagnoses in January 2018 (54%). The seasonal pattern of respiratory-related visits observed before COVID also seemed to continue across all five years.
People have always relied on urgent care for respiratory-related conditions. The COVID-19 pandemic accelerated the use of urgent care for respiratory-related issues and the use of urgent care overall. The ability to access same day, walk-in care, bypassing the need for an appointment with a primary care provider or the need to wait in an emergency room could be a reason why people choose urgent care to address their respiratory care needs.