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Patient's preferences over care settings for minor illnesses and injuries

Objectives: To identify consumers’ preferences over care settings, such as physicians’ offices, emergency rooms (ERs), urgent care centers, retail clinics, and virtual physicians on smartphones, for minor illnesses.

Data Sources: A survey conducted between 9/27/16 and 12/7/16 emailed to all University of California, Irvine employees.

Study Design: Participants were presented with 10 clinical scenarios and asked to choose the setting in which they wanted to receive care. We estimated multinomial conditional logit regression models, conditioning the choice on outofpocket costs, wait time, travel time, and chooser characteristics.

Data Collection: 5451 out of 21 037 employees responded.

Principal findings: Outofpocket costs and wait time had minimal impact on patient's preference for site of care. Choices were driven primarily by the clinical scenario and patient characteristics. For chronic conditions and children's wellvisits, the doctor's office was the preferred choice by a strong majority, but for most acute conditions, either the ER (for high severity) or urgent care clinics (for lower severity) were preferred to the office setting, particularly among younger patients and those with less education.

Conclusions: Patients have several alternatives to traditional physicians’ offices and ERs. The low impact of outofpocket costs suggests that insurers interested in encouraging increased utilization of alternatives would need to consider substantial changes to benefit structure.

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