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Urgent care: What you need to know

Consumer Reports on Health: April 2009

Everyone should know to hurry to an emergency room for a life-threatening problem such as chest pain, head trauma, or a suspected stroke. But many of the cases seen in ERs aren't true emergencies, according to data released by the Centers for Disease Control and Prevention last August. That contributes to overcrowding and long waits in ERs, plus unnecessary expenses, since treatment there costs significantly more than in a doctor's office.

But where can you turn when you need medical attention in the evening or on weekends, when your regular doctor's office is closed or when he or she can't see you right away? Filling the need for fast, walk-in health care has fueled the growth of two newer options: the retail health clinic and the urgent-care center. Here's a rundown of what each offers and when to consider them, plus a refresher on when to head for the ER.

Retail clinic

What it is: Located inside drugstores, supermarkets, and big-box retailers such as Walmart, these clinics treat a limited range of common illnesses and also provide some preventive services, such as vaccinations. They charge reasonable prices (usually covered by insurance), are open nights and weekends, don't require appointments, and are generally in places where prescriptions can be filled. They're typically staffed by nurse practitioners, registered nurses who have advanced training and can prescribe drugs. Their accessibility and low cost have made the clinics a popular choice for people who lack health insurance.

Retail clinics have spread rapidly in the last few years, from only 60 at the beginning of 2006 to 1,090 at the end of 2008. But they do have some critics: In 2007 the American Medical Association called for state and local agencies to investigate potential conflicts of interest posed by joint ventures between clinics and in-store pharmacies. And the American Academy of Pediatrics advises against taking children and teens to them. Still, they fill a convenience gap if you have the bad fortune to develop, say, a urinary-tract infection or strep throat on a Saturday and don't want to wait until your doctor's office opens on Monday morning to be treated.

When to go: If you have a basic problem and can't get in to see your regular doctor, or to get a flu shot or other common vaccination. Bring your insurance card and a list of all medications and supplements you take, and inform the clinician about any allergies or adverse drug reactions you've had. Get a record of your visit, and ask the clinic to fax or e-mail a copy to your doctor.

Cost? Low—$55 to $75 on average if you pay out of pocket, or a regular office visit co-pay if your insurance covers it.

Urgent-care center

What it is: Physician-staffed clinics that offer extended hours and provide walk-in services for acute illnesses or injuries. There were more than 8,000 such centers in the United States in 2008, according to the Urgent Care Association of America. Hospitals own and operate about 15 percent of them; the rest are privately owned.

When to go: For acute problems, including those that are beyond the scope of a retail clinic, when you cannot get an appointment to see your primary-care doctor. But they're not appropriate for emergencies. Some examples of when to go include sprains, minor burns, cuts requiring stitches, a suspected broken bone, or a minor asthma attack, as well as less serious problems.

Our medical consultants say it may be best to use an urgent-care center affiliated with a hospital, ideally the same one your primary-care doctor is affiliated with. That offers more accountability and makes it easier to get a record of the visit to your doctor. If there's no urgent-care option near you, it's still fine to go to the ER with broken bones and such-just be prepared to wait if there's a crowd.

Cost? Moderate—comparable to most doctor visits (around $120), but much less than ER care. And the insurance co-pay is likely to be lower than an ER too.

The emergency room

What it is: A hospital department that's open 24 hours a day, seven days a week, 365 days a year, and is required by federal law to care for anyone who comes in, regardless of insurance or ability to pay.

ERs typically treat people in order of severity of their case, not by when they arrive. There were more than 119 million ER visits in the U.S. in 2006, the last year for which there is national data. That's nearly a one-third increase over 1995. Experts attribute the growth in part to the country's growing population of older people and nationwide shortages of physicians and nurses.

When to go: For an emergency that seems life-threatening: chest pain, difficulty breathing, severe bleeding, head traumas, or poisoning, for example. If you need quick care but it's not a dire emergency, consider one of the other options above.

Cost? High—$400 on average.

   

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