Chart via Ezra Klein. A reader writes:

I come from a medical family (father is a GP and head of a consortium of family practices in New York, oldest sister works for him as a physicians assistant), so maybe I can add a little to Mr. Klein's analysis.  I agree with him that the disparity between an everyday person's schedule and that of primary care doctors office hours is a major issue often forgotten in the great health debate.  However, I believe that the health care industry is beginning to address this problem through the use of urgicare centers.

While I'm fuzzy on all the contractual details of urgicenters, the basic premise is that these clinics are open in the late hours - usually 5-11pm - and provide basic primary care assessment and treatment.  Typically, the doctor will only see you for one ailment to ensure a higher number visits, so hypochondriacs need not apply.  But for the typical bumps, bruises and aches that are non-emergency related, this would be the place to go.

The benefits of urgicare centers are apparent for all three parties involved: hospitals/doctors, insurers and patients.  The average cost of an emergency room visit can go well north of $1000 dollars, so insurance companies view urgicenters as a huge cost saver.  Even if a patient visit at an urgicare clinic is $200 or $300, that is still less than half the cost of an ER visit that insurers are currently shelling out to cover.  Doctors and hospitals also see first-hand the relief that urgicare provides for overcrowded emergency rooms, as non-emergency related ailments can be correctly sourced elsewhere. 

Lastly, patients will benefit in the reduced average wait-time to be seen (although when you are sick, it probably won't feel any shorter in the waiting room).  It's no wonder that many local governments and hospitals are beginning to seriously invest in these clinics, given their seemingly positive cost-benefit trade off. 

Another writes:

My current health plan (provided via my husband’s job) provides access to Urgent Care.  Urgent care does not provide 24 hr service, but has greatly expanded hours compared to my PCP office.  I am an IT consultant, and paid hourly.  Until recently I’ve been a raging workaholic, and taking time off from work to visit a doctor seemed absurd, and impossible to schedule.  When I’m sick (sore throat, sinus infection, etc) I want to see a doctor immediately.  Try scheduling with most PCP doctors and you are faced with an appointment weeks away. 

I always thought Urgent Care was substandard – until one day when I ran out of my prescription medicine for acid reflux.  (The lapse in medicine was not my fault; it was due to yet another retirement of my previous PCP, and I was stuck waiting five months to get an initial appointment with my new PCP - another huge time drain.)  It was a long holiday weekend, and I tried every over the counter medicine I could find.  The pain continued to worsen, so finally I gave in and went to Urgent Care.  The wait was short, the care was great, they gave me prescriptions to hold me over to my visit with the new PCP.  In short, it was a terrific experience as far as health care goes.  I made a decision that day that I would much rather pay the additional $10 in copay than take time off from work, which easily costs me hundreds of dollars.  (I have no idea of the difference in cost to my insurance company.)

Fortunately I have not had any urgent issues since then, but my husband has, and I was happy to drive him there for treatment.  Again, we were both pleased with the treatment, and the availability.  I will use them for all sporadic medical issues, except for a nearly annual physical which is required to keep them writing prescriptions for my chronic conditions.


There are two large hospital conglomerates here in the St. Louis market, BJC and SSM, and both operate urgent care facilities.  I work with a group of doctors that opened their own urgent care company and presently have three locations, with another one under construction.  It takes time, but people are getting used to the idea that there are alternatives to primary care and hospital emergency care.  The thing I hear most satisfying to patients of an urgent care visit is the minimal wait at the urgent care compared to a hospital.  Emergency room waiting times can be in excess of several hours if your condition is likely not to get worse during the wait.  Urgent care waits rarely exceed 30 minutes.


There's another alternative: Walk-In Clinics. They're popping up all over my home area just outside Chicago, both in drugstores and in attractive facilities built by local hospitals. Many CVS, Walgreens and Osco stores now have walk-in clinics staffed by Physician Assistants and Nurse Practitioners. They can handle any of the minor health problems that we run into.

Last week, suffering from a bad case of poison ivy, I decided on my lunch hour I needed to see a doctor and get a prescription for steroids. I didn't bother calling my regular doctor - I couldn't have gotten in for a week, at least - so I drove 10 minutes to my usual hospital-run clinic, passing one drugstore clinic and another hospital-run storefront. There were no lines; I waited in a comfortable chair in a large waiting room with flat-screen TVs for less than five minutes to see a doctor. In less than 20 minutes I was on the way out with a prescription.

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