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ER Use Starts to Decline With $50 Copayment

MANAGED CARE May 2010. © MediMedia USA
News and Commentary

ER Use Starts to Decline With $50 Copayment

MANAGED CARE May 2010. ©MediMedia USA

Fifty is a nifty number when considering how to cut back the care given in emergency rooms for nonemergency problems, according to a recent study. It seems that levying a copayment of $50 or more results in a significant reduction in ER use for non-emergent conditions.

“Copayment Levels and Their Influence on Patient Behavior in Emergency Room Utilization in an HMO Population,” in the Journal of Managed Care Medicine, says that “with a 30 to 45 percent reduction in emergent visits, a 42 to 62 percent reduction in nonemergent visits, and overall ER reduction of 33 to 49 percent for patients with ER copayments from $50 to $150, [payers’ and employers’] consideration of increasing ER copayments at least to the $50 level may serve to continue needed reductions in ER visits for nonemergent conditions.”

The study looks at ER use for about 137,000 enrollees in the Health Alliance Plan in Michigan who are treated by the Henry Ford Medical Group. The study compares data from Jan. 1 to Sept. 30, 2006, and Jan. 1 to Sept. 30, 2007, to data from 2005, before the copayments were increased.

When the copayments for doctor visits and ER visits were about the same, there seemed to be more ER visits. In such cases “patients with nonemergent conditions may consider convenience as a major factor when choosing where to receive nonemergent care.”

Physician offices aren’t open 24 hours a day and a worker doesn’t have to take time off from the job to go to the ER. In addition, “Pediatric utilization of ERs [is] usually double that of adult usage,” the study notes. Why? When children are in daycare, parents often don’t learn of a child’s illness until they come home from work.