Urgent care centres.

Although the growth of urgent care centres in the past 5 years has been phenomenal (180 urgent care centres in 1980; in excess of 3000 urgent care centres in 1985), they have been in existence since the early 1970s. Astute physicians, many of them involved in emergency medicine, saw that a significant percentage of the patient population utilizing hospital-based emergency departments consisted of people with relatively minor, but urgent, complaints. It was also obvious that the primary mission of hospital-based emergency departments was to provide medical intervention in life threatening or incipient life threatening situations. These new health care facilities, sometimes called freestanding emergency centres, were physically separate from hospitals and directed themselves to patients with ambulatory medical problems which were not truly life threatening. The success of these centres thus far can be attributed to: (1) the use of business techniques such as advertising and marketing to attract patients with episodic urgent care problems to the centre; (2) the relatively high cost of hospital-based emergency care and the lack of insurance coverage for many medical ambulatory problems; (3) the planning in these facilities to meet the patient convenience needs and the public perception that the hospital emergency department environment does not serve these personal needs. Urgent care centres began to proliferate 11 years ago with the current prototypes being founded in Rhode Island and Delaware in 1973. Emergency physicians, family practitioners and others have, in many localities, built and staffed such facilities. Their purpose was to achieve a personal degree of autonomy and self-esteem. They described themselves as being involved in 'the private practice of emergency medicine'. Hospitals have built such facilities in order to expand their patient base and to 'feed' admissions to the base institutions. The hospital will frequently utilize the services of the hospital-based emergency group to provide professional staffing. Profit-making organizations such as 'Humana' staff and operate dozens of such centres throughout the US. The typical urgent care centre is open 15 hours per day from mid-morning to mid-evening 7 days a week. The case-load consists of ambulatory patients almost exclusively and no appointments are necessary. Typically, there is an intensive marketing effort aimed at the insured patient seeking 'faster, cheaper, quality care in an environment more hospitable than the average hospital emergency room'. Where appropriate, marketing is also directed towards other patient groups such as industrial workers