Self-referred patients at the Emergency Department: patient characteristics, motivations, and willingness to make a copayment

Abstract

BackgroundIn many countries, including the Netherlands, a substantial number of patients visit the Emergency Department (ED) without a referral by a general practitioner. The goal of this study was to determine the characteristics and motivations of self-referred patients (SRPs) at the ED. The secondary objective was to explore SRPs’ opinion about copayments.MethodsA survey, in seven different languages was performed among SRPs from October 2011 until January 2012 at an academic ED in the Netherlands. Patients were included on 21 day-, 21 evening-, and 21 nightshifts during week and weekend days equally. Patient characteristics, motivations, complaints, diagnosis, and the opinion regarding copayments were examined.ResultsA total of 436 SRPs were included (response rate 82%). Forty-seven percent of the ED population was self-referred. SRPs were mainly male (58%), between 18 and 35 years (54%), Dutch (67%), single without children (42%), and low-educated (73%). The most commonly presented complaints were of musculoskeletal origin (35%). Expected need for additional medical care (e.g., X-rays, blood tests) was the reason to visit the ED for 28% of the SRPs. Around 30% of the SRPs were not prepared to pay for an ED visit. Fifty percent of SRPs were prepared to pay up to 25 or 50 EUR. Highly educated patients were willing to pay more than patients with a low level of education (p < 0.05).ConclusionsSRPs (47% of the total ED population) are often young men with musculoskeletal complaints. They are convinced that additional medical tests are necessary. About 70% of the SRPs are willing to make a copayment, half of the SRPs with a maximum between 25 EUR and 50 EUR. As highly educated SRPs are prepared to pay more, introducing copayments might influence equity in health care accessibility.

Reducing the use of out-of-hours primary care services: A survey among Dutch general practitioners

“…[23] Some studies show that co-payment is not an important driver for patient choice. [24,25] Other studies show that co-payment reduces the frequency of care use and that this decrease is greater for the social deprived patient groups. [12,26,27] So, co-payment may lead to more inequity and to unsafe situations for the social deprived patients.…”

Why patients self‐refer to the Emergency Department: A qualitative interview study

“…The reasons for self-referral found in previous questionnaire studies also can be divided into the 2 main themes our study found. 4,5,[8][9][10][11][12][13] To the best of our knowledge, this is the first qualitative study also including patients in urgent triage categories that focused on motives for self-referral to the ED. This gives a better representation of the perceptions of the entire scope of self-referred patients in the ED.…”

“…Some patients expect that they will get medical treatment faster at the ED or perceive the ED to be easier accessible. Also, people encounter difficulties in gaining an appointment with a GP or have been advised by others to directly attend to an ED . Self‐referred patients in urgent triage categories visit the ED appropriately more often .…”

“…Also, people encounter difficulties in gaining an appointment with a GP or have been advised by others to directly attend to an ED. [4][5][6][7][8][9][10][11][12][13][14] Self-referred patients in urgent triage categories visit the ED appropriately more often. 2 However, patients may view nonurgent symptoms as urgent, leading to inappropriate self-referral and unnecessary costs.…”

Emergency department crowding: Time to shift the paradigm from predicting and controlling to analysing and managing

“…Let us be clear that health care providers, and not the patients, assign the label "unnecessary" or "inappropriate" (van der Linden et al, 2014). From the patient's perspective, there is just the need for care (de Valk et al, 2014). In their point of view, crowding means bad service stemming from inadequate management.…”