The Use and Out-of-Pocket Cost of Urgent Care Clinics and Retail-Based Clinics by Adolescents and Young Adults Compared With Children

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• 作者：Charlene A. Wong ; M.D.^a ; ^b ; ^{charwong@upenn.edu} ; Alexander Bain^c ; Daniel Polsky ; Ph.D.^b ; ^c ; Raina M. Merchant ; M.D. ; M.S.H.P.^b ; ^d ; Yaa Akosa Antwi ; Ph.D.^e ; Gail Slap ; M.D. ; M.S.^a ; David Rubin ; M.D. ; M.S.C.E.^f ; Carol A. Ford ; M.D.^a
• 关键词：Primary care ; Ambulatory care facilities ; Ambulatory care ; Pediatrics ; Adolescent ; Young adult ; Health care utilization ; Health services accessibility ; Retail clinic ; Urgent care
• 刊名：Journal of Adolescent Health
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：60
• 期：1
• 页码：107-112
• 全文大小：325 K
• 卷排序：60

文摘

We describe the use and out-of-pocket cost of urgent care clinics (UCCs) and retail-based clinics (RBCs) as ambulatory care alternatives to physician offices among children, adolescents, and young adults, and examine differences in use by age.MethodsCross-sectional analysis describing diagnoses and out-of-pocket costs for 8.9 million UCC, RBC, and physician office encounters by privately insured child (aged <11 years), adolescent (aged 11–18 years), and young adult (aged 19–30 years) beneficiaries in a U.S. national administrative data set from January to June 2013. We calculate relative odds (RO) of UCC and RBC utilization by adolescents and young adults, using physician office encounters and children as reference groups.ResultsUCC (n = 286,144) and RBC (n = 89,903) visits were <5% of encounters. Upper respiratory infections were the most common diagnosis at UCCs (children 25.2%, adolescents 27.3%, young adults 26.5%) and RBCs (38.1%, 44.1%, 42.0%). The mean out-of-pocket cost was higher for UCCs (children +$38, adolescents +$29, young adults +$25) and lower for RBCs (−$4, −$15, −$18) compared with physician office encounters. For adolescents, the adjusted relative probability of UCC or RBC versus physician office encounters was 9% higher (RO = 1.09, 95% confidence interval [CI] = 1.08–1.10) and 31% higher (RO = 1.31, 95% CI = 1.29–1.34), respectively, compared with children. For young adults, the adjusted relative probability of a UCC or RBC encounter was 54% (RO = 1.54, 95% CI = 1.52–1.55) and 68% (RO = 1.68, 95% CI = 1.65–1.71) higher, respectively.ConclusionsAdolescents and young adults were more likely to visit RBCs and UCCs than children. Understanding of UCC and RBC use, cost, and quality of care is needed to inform policies on their roles in health care.