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



Cross-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.



UCC (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.



Adolescents 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.
Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania. Electronic address: charwong@upenn.edu.
Charlene A
CA
Wong
Perelman School of Medicine, University of Pennsylvania.
Alexander
A
Bain
Leonard Davis Institute of Health Economics, University of Pennsylvania; Perelman School of Medicine, University of Pennsylvania.
Daniel
D
Polsky
Leonard Davis Institute of Health Economics, University of Pennsylvania; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania.
Raina M
RM
Merchant
Department of Economics, Indiana University-Purdue University Indianapolis.
Yaa Akosa
YA
Antwi
Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania.
Gail
G
Slap
PolicyLab, Department of Pediatrics, The Children's Hospital of Philadelphia.
David
D
Rubin
Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania.
Carol A
CA
Ford
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data; D000554:Ambulatory Care Facilities / Q000191:economics* / Q000706:statistics & numerical data; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
Adolescent; Ambulatory care; Ambulatory care facilities; Health care utilization; Health services accessibility; Pediatrics; Primary care; Retail clinic; Urgent care; Young adult