Higher use, not higher prices, drove a 50% spike in urgent care spending

Urgent care spending among those with employer-sponsored insurance rose by more than 50% from 2018 to 2022, driven largely by higher use rather than rising prices, according to a new report released today by the Health Care Cost Institute (HCCI).

Urgent care centers have become a more common stop for patients seeking quick access to care and data show that growing demand is reshaping spending trends. While prices for urgent care visits gradually increased over five years, a sharp rise in visits pushed overall spending much higher. According to the report, this push sets urgent care apart from other parts of the health system where price growth has been the main driver.

The report was conducted by the nonprofit HCCI, which examines health spending trends using claims data from those with employer-sponsored insurance. Researchers set out to better understand why urgent care spending grew so quickly between 2018 and 2022 and how those trends compare with primary care and emergency room use.

“Urgent care centers have become a critical access point for patients seeking timely care, and this was especially true during the pandemic,” Katie Martin, president and CEO of HCCI, said in a news release. “Our analysis shows that while prices remained relatively stable, utilization skyrocketed—underscoring the role urgent care plays in meeting patient needs outside traditional settings.”

Martin added that while urgent care may be filling a critical gap and easing ER demand, it “deserves close attention from employers, insurers and policymakers.”

To look deeper into this utilization space, researchers used HCCI’s dataset of medical claims covering nearly 200 million people with employer-sponsored insurance. The study examined professional and outpatient claims that met specific criteria for urgent care, primary care or emergency room visits. Claims tied to inpatient stays or overlapping care settings were excluded.

Primary care visits were identified using evaluation and management codes and provider classifications from national databases. Emergency room visits were identified using standard HCPCS codes. Urgent care visits were identified using billing codes, revenue codes or place-of-service designations tied to urgent care centers. Spending and use were weighted to reflect the national employer-sponsored insurance population under age 65.

The results revealed that urgent care spending grew much faster than other care options. For example, the average spending per person on urgent care increased from $18 in 2018 to $27 in 2022, a 51.1% jump. Over the same period, spending per person on primary care office visits rose 21.1%, while emergency room spending increased 10.6%.

The main driver of urgent care spending growth was use. Urgent care visits increased to 34.5% over five years, increasing from 90 visits per 1,000 people in 2018 to 156 visits per 1,000 people in 2022. In comparison, primary care visits grew by less than 5% and emergency room visits declined slightly.

Prices happened to play a smaller role. The average price of an urgent care visit increased 12.4% from $195 to $220. That increase was similar to price growth in primary care and emergency room visits, where prices rose 15.5% and 13.5%. Unlike urgent care, price growth was the main factor driving spending increases in those settings.

Additionally, changes in the types of visits also shaped urgent care use. The report found that in 2022, infectious disease exposure accounted for 28% of urgent care visits, up from just 1% in 2018. Respiratory-related issues made up 22% of visits in 2022, down from 39% five years earlier. The infectious disease exposure category includes COVID-19-related visits, immunizations and sexually transmitted infections, with COVID-19 linked to most of these visits that year.

Although there was much growth in urgent care use, most patients still receive care in primary care offices. In 2022, there were more than 200 million primary care visits compared with fewer than 15 million urgent care visits. Even for diagnoses commonly treated at urgent care centers, primary care visits remained more frequent.

Comparing the costs of care settings shows why urgent care remains attractive. Prices and out-of-pocket costs at urgent care centers were similar to primary care and much lower than emergency rooms.

For example, treatment for a urinary tract infection averaged $218 at urgent care compared with $167 in primary care and $2,511 in the emergency room. Patients paid $83 out of pocket at urgent care compared with $545 in the emergency room.

This report suggests a number of factors that may be driving higher use, including the growing number of urgent care centers and the convenience they offer. The Urgent Care Association estimates the number of centers increased from about 10,500 in 2018 to more than 14,000 in 2022. The COVID-19 pandemic also played a major role, with millions of additional visits linked to testing, exposure and treatment.

While urgent care spending still represents a smaller share of overall health spending than primary care or emergency services, the authors said the rapid growth needs attention.