Per person spending among people with employer-sponsored insurance grew nearly 19% from 2018 to 2022, a combination of 14% price growth and 4% utilization growth. This trend reflects that prices primarily have been responsible for health spending increases over this period. Spending on urgent care grew at a substantially faster rate (more than 50%) from 2018 to 2022, and, unlike most health care categories, was driven primarily by a substantial increase in utilization.
Urgent care clinics are considered a bridge between primary care and the emergency room (ER), with the ability to treat non-life-threatening illnesses in a timely, usually same-day, manner and at a reasonable cost. Accordingly, they have the potential to fill a care gap, when patients have an acute issue they would like addressed immediately or outside of normal business hours without having to wait hours at the ER.
In this brief, we use HCCI’s unique dataset to better understand the unusual growth in urgent care spending from 2018 to 2022 by looking at how spending, use, and prices evolved over that time. To give additional context to urgent care spending, we compared spending, use, and prices of similar services in office-based primary care and ER evaluation and management visits.
Spending on urgent care grew by more than 50% from 2018 to 2022.
Among people with employer-sponsored insurance, an urgent care visit averaged $18 per person in 2018. By 2022, average per person spending on urgent care had grown to $27, a 51.1% increase. In comparison, spending per person on primary care office visits grew 21.1%, from $315 to $381, and ER spending per person grew 10.6%, from $350 to $387, during the same time period (see Figure 1).
Use of urgent care drove the increase in spending.
From 2018 to 2022, utilization of urgent care visits grew 34.5%, as shown in Figure 2. Increasing use was the primary factor in the 51% growth in spending. In 2018, there were 90 urgent care visits per 1,000 people. By 2022, there were 156 urgent care visits per 1,000 people.
Use of primary care office visits, in contrast, grew only 4.8% (from 1,625 visits per 1,000 people in 2018 to 1,703 visits per 1,000 people in 2022). ER visits decreased slightly over the same period from 176 visits per 1,000 people in 2018 to 172 in 2022 (2.5%). See Figure 3.
The average price of an urgent care visit also increased from 2018 to 2022 but to a lesser extent than utilization (Figure 4). The increase in average price of an urgent care visit also was much more in line with price increases in primary care office and ER visits. Specifically, the average price of an urgent care visit increased 12.4% from 2018 to 2022 (from $195 to $220). Over the same period, the average price of primary care office visits grew by 15.5% (from $195 to $224), and the average price of an ER visit increased by 13.5% (from $1,988 to $2,256). Unlike urgent care, price was the primary contributor to primary care and ER visit spending growth.
Exposure to infectious diseases was the primary reason for urgent care visits in 2022.
To better understand use of urgent care services, we investigated the diagnoses associated with visits and assessed how they changed over time. We grouped the diagnoses most common to urgent care into the following categories: COVID Diagnosis, Infectious Disease Exposure, Infections, Symptoms, Pain & Injury, and Respiratory-related Issues. In 2022, Infectious Disease Exposure (28%) and Respiratory-related Issues (22%) combined made up 50% of urgent care visits (Figure 5).
By comparison, in 2018, Respiratory-related Issues (39%) and Pain & Injury (19%) made up the majority of urgent care visits. Infectious Disease Exposure diagnoses made up only 1% of urgent care visits in that year.
Figure 6 shows urgent care visits by diagnosis category from 2018 to 2022. Over the five-year period, Infectious Disease Exposure Diagnoses grew at the fastest rate with approximately 28 times as many visits in 2022 (4.4 million) than in 2018 (160,000). The Infectious Disease Exposure category includes diagnoses such as Contact with and (suspected) exposure to COVID-19, immunization, and sexually transmitted infections. In 2022, 83% of visits in this category were associated with COVID-19. These are in addition to visits associated with the COVID diagnosis category.
Despite representing a substantial share of urgent care visits in 2022, the number and share of urgent care visits related to Respiratory-related Issues decreased from 2018 to 2022. They represented 39% of all urgent care visits in 2018, down to 22% in 2022 (a 29% decrease). (Note: The Respiratory-related issues category captures respiratory issues not associated with a COVID-19 diagnosis)
Despite the increase in urgent care use, more people still visit a primary care provider.
Overall, many more people sought care in primary care offices and emergency rooms than in urgent care centers. For all diagnoses, there were 208.6 million primary care office visits in 2022, 21 million ER evaluation and management visits, and 14.8 million urgent care visits. To facilitate comparison across sites, we only compared visits with diagnosis categories most commonly provided at urgent care centers. For those diagnoses alone, there were 86.9M primary care office visits, 13.6M ER visits, and 11.9M urgent care visits.
As shown in Figure 7, primary care offices and emergency rooms see a wider variety of diagnoses. The most common urgent care diagnoses made up 80% of urgent care visits, 64% of ER visits, and only 41% of primary care office visits in 2022. Though we compare diagnoses across settings, the visits themselves may not be comparable as the severity of the visit may be quite different by setting (e.g. a Pain & Injury ER visit is likely much more severe than a Pain & Injury urgent care visit).
Nevertheless, for the most common urgent care diagnoses, people go to their primary care providers more often. For example, in 2022, there were 4.4 million Infectious Disease Exposure visits at urgent care centers, which made up 28% of all urgent care visits. The same year, there were 13.9 million primary care visits for Infectious Disease Exposure (9.5 million more than at urgent care centers), but those visits only accounted for 6.8% of all primary care visits.
On average, urgent care prices were substantially lower than the ER and similar to primary care.
To examine price differences between urgent care and other settings, we compared the average price of evaluation and management visits for several common diagnosis types. The average prices of urgent care visits were similar to the average prices for primary care visits. Compared to the average price of an ER visit, however, the average price of an urgent care visit for the same diagnosis was substantially lower. For example, Figure 8 shows the average price of an urgent care visit for urinary tract infections in 2022 was $218, 30% higher than a primary care visit ($167) and over 10 times lower than an ER visit ($2,511). The price of an urgent care visit for infectious disease exposure was $215 in 2022, almost the same as a visit at a primary care office ($216) and around 5 times lower than a visit to the ER ($1,422).
Out-of-pocket spending at urgent care was lower than at the ER, comparable to primary care out-of-pocket spending.
The amount that patients pay out-of-pocket for services at urgent care centers is substantially lower than if they receive care in the emergency room and similar to what they would pay for care at their primary care provider’s office (Figure 9). For example, a person receiving treatment for a urinary tract infection at an urgent care center paid $83 out-of-pocket on average in 2022. At their primary care provider, they would have paid $61 on average. If they received treatment for a urinary tract infection in the emergency room, they would have paid $545 on average out of pocket (nearly 7 times more than at the urgent care center). The average out-of-pocket cost for an urgent care visit for infectious disease exposure was $9 in 2022, $16 for a primary care visit, and $154 for an ER visit.
Conclusion
Our analysis found that urgent care spending increased by 50% from 2018 to 2022, substantially faster than the growth of primary care or emergency room spending. Moreover, the growth in urgent care spending was primarily due to a 35% increase in use of urgent care services over that period. This upward trend in utilization among urgent care services diverges from the settings in which people might otherwise seek urgent care, like their primary care provider or the emergency room.
The supply of urgent care centers could have contributed to the increase in use we observed. The Urgent Care Association estimates that the number of urgent care centers increased from 10,484 in 2018 to 14,075 centers in 2022. It may also be that the convenience afforded by urgent care centers leads people to seek care there instead of other settings. Our data also suggest a dramatic increase in the demand of urgent care services. In 2022, we estimate that there were 3.3 million more visits to urgent care than in 2018. Those visits represent more than 4.5 million visits associated with COVID-19 infection and exposure offset by 1.3 million fewer respiratory visits and small decreases in other urgent care visits. This suggests that the COVID-19 pandemic was a primary driver in demand for and increased use of urgent care centers.
Even though use of urgent care is growing faster than primary care visits, urgent care visits make up a fraction of primary care visits, suggesting that many more people seek care from their primary care provider than urgent care centers. Though urgent care visits have similar prices and out-of-pocket spending to primary care providers, they are substantially lower cost than emergency room visits.
The data suggest that urgent care centers could be filling an important care gap and possibly defray ER visits. Accordingly, the increase in spending could reflect positive outcomes for the system at large. Nevertheless, any service with spending growth of 50% over five years warrants attention.
Methodology
We identified professional and outpatient claims that fell into our defined criteria of primary care, emergency room, or urgent care. We excluded visits that fell into more than one category or visits we suspected were a part of an inpatient stay. We used the NPPES table to identify primary care visits. We restricted primary care visits to evaluation and managements codes (new and established patients) only. We identified emergency room visits to E&M codes using the HCPCS codes, 99281-99285. To identify urgent care, claims could have met any of the following criteria: S9083, S9088 CPT Code; 0516 or 0526 revenue code; or place of service = 20. We excluded claims where the health plan was not the primary payer and allowed amounts less than or equal to $0. We weighted spending and utilization using ESI weights to develop estimates representative of the national ESI population younger than 65. ESI weights were calculated using the American Community Survey (ACS) 2021 5-year estimates Public Use Microdata Sample (PUMAS). A “broad” definition was used to define primary care which includes family medicine, general practice, geriatrics, internal medicine, pediatrics, and osteopathy, obstetricians/gynecologists, psychiatrists, psychologists, nurses, nurse practitioners, physician assistants, counselors, nurse practitioners and registered nurse school providers, and social workers, excluding physicians with specialization that are not PCP (for example, oncology). We used AHRQ’s Clinical Classification Software to roll up diagnosis codes into higher level categories.