Once an after-hours alternative to the physician office, urgent care is now a routine entry point in the U.S. healthcare system for low-acuity care, and investment in the sector has increased substantially. By 2025, approximately one in five urgent care clinics was owned by a private equity (PE) firm, and two in five were affiliated with a hospital or health system.1,2 In the policy context of a healthcare system that is expensive and does not consistently promote health, this study analyzes continuing investment in urgent care clinics.
Urgent care is uniquely, if unintentionally, positioned in the U.S. healthcare system. In one respect, urgent care is a substitute for addressing low-acuity needs when traditional primary care isn't "consumer-focused" from a scheduling perspective. Patients wait approximately 12 to 22 days for a primary care appointment, compared with same-day availability at urgent care in most markets.3 In another respect, urgent care is a less costly alternative for care that could, but should not, be delivered in a high-acuity setting (e.g., a hospital emergency department).4 As a result, the underlying rationale for urgent care utilization has implications for cost, care continuity and health status.
While the first urgent care clinics opened in the 1970s, decades passed before they became a common feature of the healthcare system. The number of clinics approximately doubled from 7,220 in 2014 to 14,655 by April 2026.5,6 The Urgent Care Association reports that 89.4% of Americans can access an urgent care clinic within a 20-minute drive, but 92% of urgent care clinics are located in metropolitan or micropolitan areas, compared to 4% in rural areas and 4% in small towns.7
PE investment in the urgent care market began in the early 2000s, scaling platforms such as NextCare, MedExpress and FastMed. By May 2025, PE-backed clinics numbered approximately 2,600, or about 18% of the national total.8 Strategic transactions in the last decade have further concentrated ownership of urgent care clinics, including acquisitions by UnitedHealth Group's Optum (MedExpress), Select Medical (Concentra) and VillageMD (Summit Health, which included CityMD).9
The increasing number of urgent care clinics has exacerbated strain in the clinical workforce, as clinic operators recruiting to staff new sites draw from an already limited supply of primary care clinicians. Perhaps unsurprisingly, primary care is among the specialties reporting the highest burnout levels and attrition intentions.10
Urgent care utilization may stem in part from the expansion of supply itself (i.e., supply-induced demand), and in part from consumer preferences for convenience and same-day access. This analysis examines how urgent care utilization has changed over time, whether patients remain loyal to a single urgent care and how the broader care patterns of urgent care clinic users compare with those of non-users.
The Trilliant Health Provider Directory and all-payer claims database were leveraged to examine visits that occurred in an urgent care clinic between 2019 and 2025. The dataset was restricted to claims that could be attributed to patients with documented health insurance enrollment for the entire calendar year where the claim occurred. Patients who did not consume any care during their enrollment period, despite having a full year of coverage, were still included in the total count of eligible patients for a given year.
For location-based analyses, the patient’s primary service area (PPSA) was calculated using their care utilization history. Rural status was determined by linking the National Center for Health Statistics (NCHS) 6-level urban-rural categorization to the ZIP code associated with the patient’s PPSA. These codes range from Central Urban (1), which reflects the most densely populated metropolitan regions, to Rural (6), which reflects areas with the lowest observed residential density. Distance between the patient and their urgent care location was determined by calculating the Haversine distance between the center of a patient’s PPSA and the physical address of the clinic.
Urgent care utilization peaked during the COVID-19 pandemic, with rates reaching 287.5 visits per 1,000 patients in 2021, before gradually declining to near pre-pandemic levels by 2025 (Figure 1). From 2019 to 2025, visits increased from 187.2 to 197.9 visits per 1,000 patients. Removing COVID-related (e.g., testing, confirmed cases) volume from the annual rates, non-COVID utilization was relatively flat over the entire period, with declining rates in both 2024 and 2025. These findings suggest that COVID-19 meaningfully, but temporarily, inflated urgent care utilization, similar to the pandemic's effect on telehealth utilization.11
As with other healthcare services, urgent care patients were more likely to be female across the study period, at 56.6%.12 In contrast, the age distribution of users evolved from 2019 to 2025, most notably for patients ages 65 and older, whose share increased from 23.2% of urgent care patients in 2019 to 33.1% of all users by 2025 (Figure 2). With respect to utilization rate, patients between 18 and 44 had the highest number of visits per 1,000 patients in a single year at 382.9 in 2021, but their utilization rate was slightly lower than patients ages 65 and older in 2025 (211.1 vs. 215.0). Overall, utilization among all age groups except those ages 65 and older has trended downward every year since 2022.
In 2025, 64.2% of patients had only one urgent care visit (Figure 3). Multiple visits per patient were the most common during the COVID-19 pandemic, though only 18.8% of urgent care patients had three or more visits in 2021.
Notably, patients with any urgent care utilization used more healthcare than patients that did not utilize urgent care, and higher urgent care utilization was associated with higher use of other services. For example, emergency department utilization increased steeply with urgent care utilization: 29.7% of patients with multiple urgent care visits also had at least one emergency department visit, compared to just 19.3% of patients who did not use urgent care at all (Figure 4). Slightly different behavior was observed in primary care. In primary care, patients who went to urgent care once were more likely to also have at least one primary care visit than patients who did not use urgent care at all (63.6% vs. 56.0%), but patients with two or more urgent care visits were no more likely to have a primary care visit than those who used an urgent care once (63.2% vs. 63.6%).
Unsurprisingly, patients who live in larger urban areas have more options for urgent care. Central urban patients had a median of 32 different urgent care locations within 10 miles of their PPSA, while rural patients only had a median of one (Figure 5). In turn, drive time to urgent care clinics varied substantially based on geography, with central urban patients traveling a median of eight miles to their urgent care visit (as a crow flies), while rural patients traveled a median of 21.8 miles.
There is an inverse relationship between urgent care access and patient loyalty, but patients are still overwhelmingly loyal to a single urgent care organization (Figure 6). Even among multi-use patients with access to at least 21 urgent care clinics within a 10-mile radius in 2025, 59.8% of them were loyal to a single clinic, and 77.9% of them were loyal to the same parent organization. This trend is also consistent over time.
Urgent care volumes have largely returned to pre-pandemic levels, and non-COVID-19 urgent care utilization was relatively flat across the study period, calling into question the substantial capital investment in the sector by health systems and PE. Given historic demand trends, the supply of urgent care sites is likely to outstrip both the demand for services and the supply of primary care providers, if it hasn’t already.
The utilization patterns also complicate the assumption that urgent care substitutes for other care. Urgent care users were more likely than non-users to use every kind of healthcare, including the emergency department, and that relationship strengthened as urgent care use increased. Rather than diverting patients from other settings, urgent care appears to be an additional point of access for high-utilization patients. If urgent care catalyzes additional demand for other services, that pattern is limited to a subset of frequent utilizers rather than all patients using urgent care. Said differently, as first reported about telehealth, urgent care seems to introduce friction cost in an industry awash with it.
Urgent care patients fall into two groups based on how often they return. Most used urgent care once in a given year, consistent with gap filling for emergent, mild acute conditions, while a steady minority used it three or more times.
Health systems invest in urgent care as a “loss leader,” believing that attracting consumers to their brand for low-acuity care will create loyalty for higher-acuity care. Some health systems have already invested in their own urgent care platform while others have acquired PE-backed urgent care operators. This analysis reveals a high degree of loyalty not only to an urgent care brand but also to a specific urgent care location for low-acuity care, even in markets with numerous urgent care brands and locations. Among those frequent users, the majority returned to the same location on every visit and an even larger share to the same parent organization, even in markets with many alternatives. Whether that loyalty reflects patient preference or the constraints of insurance networks is an open question that warrants further study.
High loyalty for low-acuity care does not by itself confirm the loss-leader rationale, which depends on downstream capture - that is, whether this loyalty leads to retention for higher-acuity services within the same system. A forthcoming analysis will examine that question directly, drawing on a curated set of blinded health system examples to trace how urgent care use affects patient retention within a system and to assess whether investment in a sector with flat demand produces the referral patterns operators expect.
The findings do not reflect an urgent care model that is clearly resolving the access and low-acuity care problems it was designed to address, nor one that is expanding and thriving. Urgent care has instead become another setting where frequent users of healthcare receive care, relieving strain on an already overloaded system. The implications extend beyond any single operator. Access remains thin where need is often greatest, with rural patients facing a median of one nearby center and travel distances more than twice those of urban patients.
Urgent care clinics exhibit more “free market” economic principles than most of the health economy, reflecting their ubiquitous service offerings at comparatively low costs. Because the urgent care sector is not too big to fail but rather too small to matter to Federal policymakers, traditional economic principles of supply, demand and yield are more likely to shape the future of the urgent care sector than, for example, CAR-T therapies.
PE firms exist to create returns on invested capital, and they do that by “exiting” to another acquirer, whether another financial sponsor or a strategic operator, most likely a health system. The continued opening of new urgent care clinics despite flat consumer demand will eventually force PE firms to consolidate or exit markets with excess capacity. When that happens, the key valuation metric for any acquirer should be financial viability at the individual clinic level. Given the observed loyalty metrics to a specific location, some clinics may be consistently profitable while others may be unviable.
Before making incremental investments in urgent care, the question for every health system is this: does high loyalty for low-acuity care translate into capturing higher-acuity services within the same system?