Ho V, et al. - Given that wait times in overcrowded emergency departments (EDs) could be reduced with freestanding emergency departments (FrEDs) but with a possibility of increased usage and overall spending for emergency care. Authors examined whether the number of FrEDs entering a local market is associated with overall spending on emergency care. Data were obtained from Arizona, Florida, North Carolina, and Texas in Blue Cross Blue Shield Axis; a limited data set of deidentified insurance data claims that was linked to Public Use Microdata Area (PUMA) data from the American Community Survey; and lists of licensed FrEDs from state agencies. In Texas, Florida, and North Carolina but not in Arizona, they observed an association of entry of an additional FrED in a PUMA with a 3.6 percentage point (pp) increase in emergency provider reimbursement per insured beneficiary. They observed a 0.18 (CI = 0.12 to 0.23) increase in the number of emergency care visits per 100 enrollees in correlation to the entry of an additional FrED in Texas, Florida, and Arizona. In Texas, Florida, and Arizona, they observed an increase in estimated out-of-pocket payments for emergency care by 3.6 pp with the entry of a FrED, but a decline in these estimates by 15.3 pp was noted in North Carolina. Findings thereby indicate that FrEDs have not functioned as substitutes for hospital-based EDs but have increased the local market spending on emergency care in three of four states’ markets where they have entered. They recommend state policymakers and researchers to precisely track spending and utilization of emergency care as FrEDs disseminate to adequately understand their potential health benefits and cost implications for patients.