(BOSTON, MA AND LOS ANGELES, CA) — Urgent care centers and retail health clinics are proliferating rapidly across the United States and playing an important role in providing COVID-19 tests and vaccines. However, according to a new report by Community Catalyst and the National Health Law Program (NHeLP), these so-called “convenient care” providers are largely under-regulated. As a result, in many states there is no way to ensure people who live in low-income and medically underserved communities are getting access to needed care. In addition to the access and affordability concerns, there are also questions about the availability of the range of services, particularly at facilities operated by or run in partnership with Catholic health systems.
The report — Making “Convenient Care” the Right Care for All: Improving State Oversight of Urgent Care Centers and Retail Health Clinics — finds that the number of urgent care centers across the country grew from 7,500 in 2015 to 10,000 in 2020, while retail health clinics (most often located in drug stores or big retail outlets) jumped from 700 in 2013 to 2,700 in 2019. By late 2020, urgent care centers were providing more than 725,000 COVID-19 tests per week, and many had long lines of people waiting outside.
Most states do not issue facility licenses for urgent care centers or retail health clinics, which often operate under an individual physician’s license. As a result of this lack of regulation or under-regulation, Community Catalyst and NHeLP found:
- In most states, these facilities are not required to serve people who are uninsured or have Medicaid, and may have no charity care policy.
- Urgent care centers are common in middle-class communities where residents have commercial health insurance, but often missing in low-income and medically-undeserved areas.
- Consumers seeking urgent sexual, reproductive and LGBTQ+-inclusive care cannot count on being able to obtain those services at neighborhood urgent care centers or retail health clinics, especially those operated by Catholic health systems.
“Health equity is a growing concern as we see the convenient care arm of the health industry becoming larger and larger,” said Lois Uttley, Women’s Health Program Director at Community Catalyst, co-author of the report. “We need to make sure these facilities are serving everyone who needs their care and are not turning away uninsured people, steering away from low-income communities or refusing to provide urgent reproductive and sexual health care services and LGBTQ+-inclusive care.”
The report identified a few states that have taken steps to enact legislation that could serve as models for oversight of urgent care centers and retail health clinics. In Vermont, for example, urgent care centers are forbidden to discriminate on the basis of an individual’s health insurance status or type of coverage. Other states — such as New York, Illinois and North Carolina — have considered, but failed to adopt, proposals to strengthen state oversight of convenient care facilities.
Robust state oversight is needed to ensure that community health needs are met, including meaningful efforts to reduce racial and ethnic disparities
“Some states have worked to tackle the central issues of coverage, transparency and the types of services offered at urgent care centers and retail health clinics,” said Amy Chen, a senior staff attorney at NHeLP and co-author of the report. “Robust state oversight is needed to ensure that community health needs are met, including meaningful efforts to reduce racial and ethnic disparities.”
The report presented the following recommendations on how to strengthen state oversight of convenient care facilities:
- State licensing requirements and Certificate of Need programs should be updated to apply to this growing market.
- Urgent care centers and retail clinics should be required to contract with Medicaid, and given targets for percentage of service to Medicaid-insured and uninsured consumers as a condition of state Certificate of Need approval.
- States should set up accreditation processes to enforce standardization across sites, mandate the provision of basic health care services and enforce nondiscrimination provisions.
- States should require care coordination between urgent care centers, retail clinics, primary care services and hospitals to promote a strong continuum of care and ensure the highest quality of care.
Community Catalyst is a leading non-profit national health advocacy organization dedicated to advancing a movement for health equity and justice. We partner with local, state, and national advocates to leverage community power so all people can influence decisions that affect their health. Health systems will not be accountable to people without a fully engaged and organized community voice. That’s why we work every day to ensure people’s interests are represented wherever important decisions about health and health care are made: in communities, statehouses, and on Capitol Hill. For more information, visit www.communitycatalyst.org. Follow us on Twitter @CommCatHealth.
The National Health Law Program protects and advances the health rights of low-income and underserved individuals and families. We advocate, educate, and litigate at the federal and state levels to advance health and civil rights in the U.S. Visit www.www.healthlaw.org to learn more about our work.
