Having a bad cold with high fever, chills, and headache on the weekend. Waking up in the middle of the night with stomach cramps, nausea, and diarrhea. These are examples of medical conditions that in the past might have sent patients to the emergency room if they felt they could not wait until their doctor was able to see them during normal office hours. That was then. Today, patients have alternatives: Urgent care centers, retail clinics, virtual physicians who diagnose over the internet, nurse advice lines, and--in some major cities--physicians who make house calls. But what care settings are patients likely to choose? To answer this question, we surveyed more than 5,000 employees at the University of California, Irvine campus, a diverse population representing all socioeconomic strata. Based on an analysis of their responses, we created a publicly available simulation model (https://www.medicine.uci.edu/iteqc/wheredopatientsgo) that allows users to understand what care settings are most likely to be chosen by different populations when faced with different clinical situations. The model can inform policymakers and researchers in their efforts to understand the complex relationships between out-of-pocket costs, wait time, severity of the medical condition, and population characteristics that influence the choice of care setting. The general findings of the study are that patients are more likely to choose less costly care settings and settings with less wait time, but that cost is usually more important than wait time. Both those choices depend on the severity of the injury or the disease. Travel time does not affect choice.
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