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Gain Insights About Your Patients' Preferences for Care Settings

By Christopher Cheney  
   July 30, 2019

In a recent survey, out-of-pockets costs and wait times had a limited impact on patient choice of care settings.

When patients choose a care setting, the main drivers are the nature of medical conditions and patient characteristics, new survey data indicates.

In recent decades, healthcare providers have developed several alternatives to traditional physician office and emergency room visits, including urgent care centers, retail clinics, telemedicine, and app-driven home health visits.

Survey data collected from more than 5,000 University of California-Irvine employees shows patients make rational choices of care settings based largely on medical condition severity and patient characteristics, a journal article published in Health Services Research shows.

"Out‐of‐pocket costs and wait time had minimal impact on patient preference for site of care. Choices were driven primarily by the clinical scenario and patient characteristics," the HSR researchers wrote.

Survey participants were given 10 clinical scenarios of varying severity, then they were asked to pick a preferred care setting. The survey generated several key data points:

  • Most survey participants chose physician office visits for chronic conditions and child well-visits.
  • For clinically severe and time-sensitive scenarios, survey participants were inclined to choose the ER or urgent care. For example, 68.9% chose the ER for chest pain, and 41.9% chose urgent care for a deep cut.
  • In non-time-sensitive scenarios, physician office visits were highly preferred. For example, 45.4% preferred physician office visits for immunizations.
  • For diarrhea, parents were much more likely to "wait and see" for themselves (29.9%) than for their children (5.8%). For most parents, a physician office or urgent care center was the preferred setting to take children for treatment of diarrhea.
  • Increases in out-of-pocket expenses generated single-digit percentage point changes in patient preferences for care settings. For physician office visits, a 20% increase in out-of-pocket costs decreased the likelihood of a survey respondent picking that setting by 3.6 percentage points. For urgent care, a 20% hike in out-of-pocket costs decreased selection of that care setting by 1.5 percentage points.

Interpreting the data

The survey results for out-of-pocket costs indicate payers would have to make significant changes to benefit structures to increase utilization of alternatives to tradition physician office visits and ERs. The lead author of the HSR article told HealthLeaders that payers could make substantial hikes in out-of-pocket costs to influence care setting preferences.

"If the insurer wanted to encourage virtual physicians visits, rather than having virtual visits at equal cost to an actual physician office, which it is now for most University of California-Irvine employees, the insurer could lower the cost of virtual visits to a few dollars and increase the cost of an actual office visit," said Dana Mukamel, PhD, a professor of medicine, public health, and nursing at UCI.

In addition to medical condition severity and patient characteristics, patient familiarity with a care setting was a significant preference driver, she said. "In general, we found that people were more likely to choose those providers that they had an experience with in the previous 12 months."

Telemedicine visits were a recent offering to UCI employees, which worked against their selection in the survey's care scenarios, but this preference pattern will likely change over time, Mukamel said. "I expect that as more people gain experience with this option, we will see more people making this choice."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


Patients have a wide range of care setting options, from traditional physician office visits and the ER to new settings such as telemedicine visits.

In non-time-sensitive scenarios such as immunizations, physician office visits were highly preferred in a recently published survey.

Telemedicine visits are expected to become more popular as patients gain more familiarity with them.

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