The Impact of Cost Sharing on Emergency Department Use

O'Grady, Kevin F.; Manning, Willard G.; Newhouse, Joseph P.; Brook, Robert H.

doi:10.1056/nejm198508223130806

Cited by 131 publications

(75 citation statements)

References 9 publications

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“…These results show more marked reductions in visits due to an increase in co-payments for chronic or non-serious diseases than for emergency or serious diseases. These results were consistent with those of previous studies [9][10][11][12][13][14][15] . The upper limit expenditures of co-payments per month were ≤ 5,000 yen in 67.9% of the subjects with hypertension and 64.1% of those with diabetes mellitus, showing that 5,000 yen is the limit in many insured people.…”

Section: Association Between Diseases and Reductions In Visits Due Tosupporting

confidence: 94%

A Study on a Reduction in Visits to Physicians after Introduction of 30% Co-payments in the Employee Health Insurance in Japan

et al. 2004

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The purpose of the study is to evaluate influences of the introduction of 30% co-payments on potential visit behavior using a questionnaire in order to determine whether "employment state of the spouse" and "number of dependent children", as indicators of economic backgrounds, affect visits to physicians in a health insurance society. The subjects were 1,674 insured consisting of 1,165 males and 509 females, who underwent a regular health examination in July 2002, in a health insurance society. In the survey, they were asked whether the subject "will reduce" or "will not reduce" visits to physicians due to the increase in co-payments in the health insurance system scheduled in 2003. Multivariate analyses showed that "employment state of the spouse" was significantly related to the reduction in visits for myocardial infarction or stroke, cancer or heart disease, and hypertension and diabetes mellitus. Concerning "number of dependent children", it was related to the risk of reducing visits to physicians for myocardial infarction or stroke, trauma or fracture, cancer or heart disease, and low back pain or knee pain. Finally, upper limit expenditures of co-payments of physicians to visits due to hypertension and diabetes mellitus were related to "number of dependent children". The study results suggest that "employment state of the spouse" and "number of dependent children" are significant factors to affect potential visits to physicians after the introduction of 30% co-payments.

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Section: Association Between Diseases and Reductions In Visits Due Tosupporting

confidence: 94%

A Study on a Reduction in Visits to Physicians after Introduction of 30% Co-payments in the Employee Health Insurance in Japan

et al. 2004

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“…Even modest copayments could reduce low-acuity ED visits without reducing emergency visits. [56][57][58] However, to our knowledge, such copayments have not been used for pediatric Medicaid patients. It is worth noting that imposing copayments might reduce overcrowding but might only shift costs instead of reducing them.…”

Section: The Future Of Pediatric Emergency Medicinementioning

confidence: 99%

Emergency Care For Children In The United States

2013

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A formal emergency care system for children in the United States began in the 1980s with the establishment of specialized training programs in academic children's hospitals. The ensuing three decades have witnessed the establishment of informal regional networks for clinical care and a federally funded research consortium that allows for multisite research on evidence-based practices. However, pediatric emergency care suffers from problems common to emergency departments (EDs) in general, which include misaligned incentives for care, overcrowding, and wide variation in the quality of care. In pediatric emergency care specifically, there are problems with low-volume EDs that have neither the experience nor the equipment to treat children, poor adherence to clinical guidelines, lack of resources for mental health patients, and a lack of widely accepted performance metrics. We call for policies to address these issues, including providing after-hours care in other settings and restructuring payment and reimbursement policies to better address patients' needs.

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“…This is an expensive practice that contributes to overcrowding and decreased continuity of care. [7][8][9][10] Evidence suggests that ED overcrowding is associated with adverse clinical outcomes, [10][11][12] and proposed solutions have ranged from streamlining inpatient admissions to expanding primary care. [13][14][15] It is important to understand the current patterns of ED use if primary health care initiatives are to effectively reduce ED workloads and improve overall health.…”

Section: Résumémentioning

confidence: 99%

Factors associated with choosing the emergency department as the primary access point to health care: a Canadian population cross-sectional study

Ohle

Perry

2016

CJEM

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Objective : Approximately 4.3 million Canadians are without a primary care physician, of which 13% choose the emergency department (ED) as their regular access point to health care. We sought to identify factors associated with preferential ED use over other health services. We hypothesized that socioeconomic barriers (i.e., employment, health status, education) to primary care would also prevent access to ED alternatives. ) reduced respondents use of the ED. The reduced odds of ED use were independent of chronic conditions, mental health, gender, poor mobility, province, and age. Conclusions : Low socioeconomic status dictates preferential ED use in those without a primary care physician. Specific policy and system development targeting this at-risk population are indicated to alter ED use patterns in this population. RRA : 0,68 [IC à 95 % : 0,88]) étaient des facteurs qui avaient pour effet de diminuer l'utilisation des SU. Les cotes d'utilisation moindre des SU se sont révélées indépendantes des affections chroniques, de la santé mentale, du sexe, du manque de mobilité, de la province ou de l'âge. Conclusions: Des facteurs liés à un faible statut socioéconomique jouent un rôle important dans l'utilisation des SU de préférence à d'autres points de services chez les personnes n'ayant pas de médecin de premiers recours. L'élaboration de politiques et de systèmes qui ciblent tout particulièrement cette population à risque est donc indiquée afin de l'inciter à modifier ses habitudes d'utilisation des SU.

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The Impact of Cost Sharing on Emergency Department Use

Cited by 131 publications

References 9 publications

A Study on a Reduction in Visits to Physicians after Introduction of 30% Co-payments in the Employee Health Insurance in Japan

A Study on a Reduction in Visits to Physicians after Introduction of 30% Co-payments in the Employee Health Insurance in Japan

Emergency Care For Children In The United States

Factors associated with choosing the emergency department as the primary access point to health care: a Canadian population cross-sectional study

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