Urgent Care

Urgent Care: Same-Day Care Between General Practice and the Emergency Department, and Whether It Saves Money

Urgent care is medical care for a problem that needs to be seen right away, such as a sprain or a urinary infection, when the patient's health is not in serious danger and an emergency department is not needed. The HealthCare.gov glossary defines it as care for "an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe it requires emergency room care". For health economists the question is what happens to costs and health when this care moves out of emergency departments, which charge far more per visit. This page covers US and English settings, the evidence on substitution versus new use, a break-even calculation and use in economic evaluation.

Urgent care between primary care and emergency care

The tiers are separated by how serious the problem is and how soon care is needed. HealthCare.gov describes an emergency medical condition as one so serious that a reasonable person would seek care right away to avoid severe harm, and primary care as prevention, wellness and treatment for common illnesses, often within a long-term relationship with a clinician. Urgent care sits between them: the need cannot wait for a routine appointment, but life and limb are not at risk. An English Department of Health definition, quoted by Turner and colleagues, also covers perceived need: the range of responses to people who require or perceive the need for urgent advice, care, treatment or diagnosis.

In the United States, Weinick, Burns and Mehrotra describe two main settings. Urgent care centres are most typically freestanding physicians' offices with extended hours, on-site X-rays and laboratory testing, and a range of care that includes fractures and lacerations; retail clinics sit in retail stores, are typically staffed by nurse practitioners and treat a narrow range of conditions. Emergency departments are never closed, see much sicker patients and, under federal law, must examine every patient regardless of ability to pay.

In England, NHS England's urgent treatment centres principles and standards (publication PR2003, updated October 2023) bring walk-in centres, minor injury units and urgent care centres under one standard model. Urgent treatment centres treat minor injuries and illnesses that are urgent but not life or limb threatening, for all ages, and must open at least 12 hours a day, 7 days a week. They see booked and walk-in patients, but the public is encouraged to contact NHS 111 first. Their activity is reported as Type 3 on the Emergency Care Data Set and counts against the 4-hour A&E standard, so in English statistics urgent treatment centre activity sits inside A&E activity.

Why urgent care matters economically

The economic case rests on a price gap. In Blue Cross Blue Shield of Texas claims, Ho and colleagues found an average price of USD 164 (2012) and USD 168 (2015) per urgent care centre visit, and prices for the same diagnosis almost 10 times higher in emergency departments. Mehrotra and colleagues, in a Minnesota health plan, costed whole episodes of otitis media, pharyngitis and urinary tract infection, including follow-up visits, drugs and tests: episodes starting at retail clinics cost USD 110, against USD 166 in physician offices, USD 156 in urgent care centres and USD 570 in emergency departments, although emergency patients may have had more severe acute illness despite matching, and quality scores were lower in emergency departments than in the other settings.

Weinick and colleagues estimated that 13.7% to 27.1% of all US emergency department visits could be managed at an urgent care centre or retail clinic, a potential saving of about USD 4.4 billion a year, resting on three assumptions, the first being that every eligible patient would switch. They warned that new demand created by easier access could offset some or all of the savings, and that because life-saving emergency care is expensive, spreading its costs over fewer visits would raise the cost per remaining visit. The saving from diverting a minor case is therefore its marginal cost, which is lower than the average cost per emergency visit. England's standards state the same aim, to reduce attendance at emergency departments, and an urgent treatment centre at the front door of an emergency department lets emergency specialists concentrate on higher acuity patients.

Substitution or addition: what the evidence shows

Whether urgent care saves money depends on the counterfactual: what each patient would have done without it. A visit that replaces an emergency department visit saves money; one that replaces a general practice visit saves little or adds cost; a visit that would not otherwise have happened adds cost, although it may also add health. Lower travel time, waiting time and out-of-pocket price raise the quantity of care demanded, as the price elasticity of demand predicts, and in insured populations this overlaps with moral hazard. The US evidence mostly finds addition outweighing substitution.

The studies answer different questions. Allen and colleagues used a difference-in-differences design and show real diversion while centres are open, concentrated at the emergency departments with the longest waits. Wang and colleagues show that the diversion is small relative to the extra urgent care used, so spending on lower-acuity care rose despite the tenfold price gap.

English evidence is mixed. In a controlled before and after study of the four NHS 111 pilot sites, Turner and colleagues found no change overall in emergency department attendances or urgent care use, and overall emergency and urgent care activity up 4.7% to 12% a month in each site; the authors asked whether the service was creating supplier-induced demand. In Greater Manchester, Whittaker and colleagues found that evening and weekend general practice opening was associated with a 26.4% relative reduction in patient-initiated emergency department visits for minor problems and a 26.6% reduction in their cost (GBP 767,976), but no significant change in total emergency department visits; missing running costs and health outcomes prevented a full cost-effectiveness assessment.

Worked example: the break-even substitution rate

Steps 1 and 2 use figures reported by, or implied by, Wang and colleagues; step 3 is illustrative. Of $N$ new urgent care visits in an area, a share replaces emergency department visits, a share replaces office or general practice visits and the rest is new use.

$$ \Delta C = N \left( c_U - s_E c_E - s_O c_O \right) $$

where $\Delta C$ is the change in total spending, $N$ is the number of urgent care visits, $c_U$ is the cost of an urgent care visit, $c_E$ and $c_O$ are the costs of an avoided emergency department visit and office visit, and $s_E$ and $s_O$ are the shares of urgent care visits that replace each. Setting the change in spending to zero gives the break-even emergency substitution share:

$$ s_E^{*} = \frac{c_U - s_O c_O}{c_E} $$

where $s_E^{*}$ is the share of urgent care visits that must replace an emergency department visit for spending to stay flat, and the other symbols are as above.

1. Cost per urgent care visit (USD). The implied cost per urgent care visit is 6,327 ÷ 37 = 171. An avoided lower-acuity emergency visit costs 1,646, and 1,646 ÷ 171 = 9.6, matching the reported tenfold price gap.
2. Break-even with emergency substitution only (USD). With no office substitution the break-even share is 171 ÷ 1,646 = 0.104, about 1 urgent care visit in 9.6. The estimated share was 1 in 37, or 0.027. Each urgent care visit therefore avoids 1,646 ÷ 37 = 44.49 of emergency spending and adds 171 − 44.49 = 126.51 net.
3. Adding office substitution (illustrative, USD). If 30% of urgent care visits also replaced an office visit costing 150, each visit saves a further 0.30 × 150 = 45. Net spending per visit becomes 171 − 44.49 − 45 = 81.51, and the break-even emergency share falls to (171 − 45) ÷ 1,646 = 126 ÷ 1,646 = 0.077.

At the substitution rate observed, urgent care raises spending. Office substitution would have to reach about 84% of urgent care visits (126.51 ÷ 150) before spending stayed flat. That does not make it poor value: the extra USD 81.51 to USD 126.51 per visit may buy faster access and care some patients would otherwise have gone without, and a cost-effectiveness analysis has to value those effects instead of judging urgent care by savings alone.

How urgent care enters economic evaluation

An evaluation of an urgent care service compares two whole systems of care, with and without the service, not one urgent care visit with one emergency visit. A decision tree can follow patients with a given need through the settings they would use under each option, with probabilities for substitution, new use, onward referral and repeat attendance. Weinick and colleagues found that 2.2% of urgent care centre visits ended in referral to an emergency department; such referrals and follow-up belong in the comparison, which is why Mehrotra and colleagues costed whole episodes instead of single visits.

Four further choices change the result.

• Counterfactual use. Substitution shares are best estimated from quasi-experimental designs such as the difference-in-differences and controlled before and after studies above, not from the share of emergency attendances an algorithm classes as non-urgent.
• Unit costs. Payer prices (US claims) and resource costs (NHS costing) differ, and a diverted visit saves only its marginal cost because emergency departments carry large fixed costs.
• Perspective. A health system perspective counts provider costs; a wider one adds patient travel, time off work and waiting.
• Outcomes and equity. Quality, safety of self-triage and missed diagnoses need measuring, since a cheaper setting that misses serious illness moves costs elsewhere. Allen and colleagues found larger falls in uninsured (21%) and Medicaid (29.1%) emergency department visits than in visits overall (17.2%), and NHS England notes disproportionately high use of Type 3 services by people from the most deprived areas.

For commissioners deciding whether to fund an urgent treatment centre, a budget impact analysis shows the effect across emergency, urgent and primary care budgets, while a cost-effectiveness analysis asks whether any extra spending buys enough health and access to care to justify its opportunity cost.

Common misreadings

A tenfold difference in price per visit does not mean a tenfold saving, because most urgent care visits replace cheaper care or are new use. New use may meet real need.

• "Inappropriate" attendance is an estimate. Weinick and colleagues used an algorithm developed by Billings and colleagues, and Allen and colleagues the NYU ED algorithm; such algorithms work from the diagnosis recorded after the visit, while patients choose where to go before they know it.
• US results do not transfer directly to the NHS. US studies measure prices paid by insurers and patients in markets with copayments; in England care is free at the point of use and urgent treatment centre activity is counted within A&E.

Sources

• HealthCare.gov. Glossary: Urgent care; Emergency medical condition; Primary care. US Centers for Medicare & Medicaid Services; accessed 2 October 2026. https://www.healthcare.gov/glossary/urgent-care/
• NHS England. Urgent treatment centres: principles and standards. Publication reference PR2003. First published 13 July 2017; updated 23 October 2023. https://www.england.nhs.uk/long-read/urgent-treatment-centres-principles-and-standards/
• Weinick RM, Burns RM, Mehrotra A. Many emergency department visits could be managed at urgent care centers and retail clinics. Health Affairs. 2010;29(9):1630-1636. doi:10.1377/hlthaff.2009.0748
• Mehrotra A, Liu H, Adams JL, et al. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Annals of Internal Medicine. 2009;151(5):321-328. doi:10.7326/0003-4819-151-5-200909010-00006
• Ho V, Metcalfe L, Dark C, et al. Comparing utilization and costs of care in freestanding emergency departments, hospital emergency departments, and urgent care centers. Annals of Emergency Medicine. 2017;70(6):846-857. doi:10.1016/j.annemergmed.2016.12.006
• Ashwood JS, Gaynor M, Setodji CM, et al. Retail clinic visits for low-acuity conditions increase utilization and spending. Health Affairs. 2016;35(3):449-455. doi:10.1377/hlthaff.2015.0995
• Poon SJ, Schuur JD, Mehrotra A. Trends in visits to acute care venues for treatment of low-acuity conditions in the United States from 2008 to 2015. JAMA Internal Medicine. 2018;178(10):1342-1349. doi:10.1001/jamainternmed.2018.3205
• Wang B, Mehrotra A, Friedman AB. Urgent care centers deter some emergency department visits but, on net, increase spending. Health Affairs. 2021;40(4):587-595. doi:10.1377/hlthaff.2020.01869
• Allen L, Cummings JR, Hockenberry JM. The impact of urgent care centers on nonemergent emergency department visits. Health Services Research. 2021;56(4):721-730. doi:10.1111/1475-6773.13631
• Turner J, O'Cathain A, Knowles E, Nicholl J. Impact of the urgent care telephone service NHS 111 pilot sites: a controlled before and after study. BMJ Open. 2013;3(11):e003451. doi:10.1136/bmjopen-2013-003451
• Whittaker W, Anselmi L, Kristensen SR, et al. Associations between extending access to primary care and emergency department visits: a difference-in-differences analysis. PLoS Medicine. 2016;13(9):e1002113. doi:10.1371/journal.pmed.1002113