Emergency Care Centers, Hospital Performance and Population Health

A core challenge for healthcare systems is ensuring timely care for critical conditions while efficiently managing lower-complexity cases. Hospitals, often overburdened by both, struggle to balance these demands and allocate resources effectively. Many countries have responded by introducing alternative 24/7 facilities to relieve hospital strain and improve patient outcomes, yet evidence on their impact remains limited. We evaluate the introduction of freestanding Emergency Care Centers (UPAs) within Brazil's publicly funded health system, leveraging rich administrative data. We find that UPAs reduced hospital outpatient procedures by 30% and hospital admissions for ambulatory-sensitive conditions by 24–37%, enabling hospitals to focus on more complex cases, such as surgeries and obstetric admissions, which increased by 25%. We see a 13% reduction in inpatient mortality, particularly in intensive care and for conditions best suited to hospital treatment. While some deaths were displaced to UPAs, there was a decline in population-level mortality of 1.8%, albeit this is not statistically significant. Our findings show how an intermediate tier of emergency care reshapes patient sorting, alleviates hospital congestion, and improves hospital performance in an overstretched public health system.