Living Near Retail Clinics Linked to Fewer Avoidable ED Visits

Having a retail health clinic nearby can make patients less likely to visit the emergency department (ED) for minor or preventable conditions, according to new research.

The study, published as a working paper by the National Bureau of Economic Research, examined ED use in New Jersey for 3 classes of conditions between 2006 and 2014. Emergent but preventable conditions, such as influenza or complications from diabetes, that often necessitate ED visits but can be avoided through sufficient primary care, and minor conditions like sore throats and ear infections that could be treated at a doctor’s office instead of the ED. A third class of conditions designated as the control group included events like childbirth or fractures that are not preventable and are generally only treated in the ED.

Researchers compared the rates of ED utilization for each of these 3 categories among both residents who lived within 2 miles of a site where a retail clinic had operated (“near”) and those who lived 2 to 5 miles from a retail clinic site (“far”). Their hypothesis was that those who lived near the retail clinics would be most likely to visit them instead of the ED, due to the convenience and lower prices offered at the in-store clinics.

In their statistical analyses, the study authors first considered how the availability of a primary care physician affects ED usage, and then how the introduction of a retail clinic impacts ED use when primary care is available or unavailable. Their data was gathered from Merchant Medicine’s list of retail clinic locations and operation dates as well as data on ED use from the New Jersey Department of Health.

The researchers found that ED visits for influenza and diabetes fell by 13.6% and 3.6%, respectively, among those near an open retail clinic, confirming that the increased use of preventive care when a retail clinic is nearby was associated with fewer ED visits for emergent but preventable conditions.

They also found reductions in ED visits for minor conditions (ranging from 5.7% for urinary tract infections, sprains, and strains to 12% for sore throat) among those near an open retail clinic, indicating these patients substituted away from the ED when retail clinics were available. As expected, there was no association between proximity to retail clinics and the rates of ED utilization for genuinely emergent conditions like childbirth.

The finding that retail clinic proximity can impact ED utilization, either through prevention or substitution, could have important implications for healthcare expenditures. Having a nearby retail clinic was linked to estimated annual cost savings of $817,492 per 100,000 people, or a potential of more than $70 million in cost savings if extrapolated to the entire population of New Jersey. It would take over 700,000 yearly retail clinic visits at $100 per visit to offset the savings resulting from lower ED usage.

Furthermore, the researchers pointed out that preventing illness is “socially beneficial” even beyond the effects on healthcare costs, meaning that retail clinics’ potential to improve public health could make them a logical target of policy interventions.

“The fact that retail clinics reduce the burden of preventable diseases may swing the balance of welfare calculations in favor of regulatory changes that promote competition from retail clinics,” the study authors concluded.