Tele-triage, care substitution, and health: Evidence from quasi-randomly assigned nurses

Patients experiencing acute health symptoms often face uncertainty about how and where to receive care. We study patients who call a nurse advice line and receive one of four recommendations: emergency department (ED), urgent care (UC), primary care (PC), or self-care (Home). Leveraging an extension of examiner designs that recovers margin-specific effects for each pair of adjacent recommendations (ED-UC, UC-PC, PC-Home), we estimate the impact of nurse recommendations on both patient decisions and their subsequent health outcomes. We find that recommendations have large impacts on patient decisions at each margin. We then show that UC recommendations reduce 28-day healthcare costs by $404 relative to ED recommendations and by $247 relative to PC recommendations, suggesting substantial potential for cost savings through improved triage.