Safety and Financial Ramifications of ED Copayments Study (SAFE) Final rept. (July 15, 2001-June 30, 2004)

摘要

Prior studies suggest that copayments decrease utilization, but have not had adequate sample sizes to detect potential adverse clinical effects. In a quasi-experimental study with concurrent controls, we evaluated the effect of an ED copayment on unfavorable clinical event rates and total direct medical costs. We supplemented these analyses with telephone interviews. Among commercially-insured subjects, the relative rates of ED visits were lower for subjects with higher ED copayments. In addition, the relative rates of hospitalization, ICU admission, and death did not increase with larger copayments. Similarly, the mean monthly total direct medical costs were lower with larger copayments, compared to no copayment. The findings among Medicare subjects were comparable. The interviews suggested that patients who changed their behavior, generally sought care either from another location such as the outpatient clinic or contacted a provider by telephone. Less than 2% of subjects reported avoiding care altogether in response to the copayment.