Copayments Fail to Hinder Emergency Department Use for Nonurgent Care

Requiring Medicaid patients to make a copayment when seeking emergency department (ED) care for nonurgent issues did not significantly reduce ED use, according to a new study published in JAMA Internal Medicine.

The study is the first to gauge the effect of the Deficit Reduction Act of 2005, which allowed states to authorize hospitals to enforce copayments for Medicaid patients seeking costly nonemergency care in the ED. Investigators sampled 3122 Medicaid patients in 8 states that adopted $3 to $15 copayments and 7433 Medicaid patients in 10 states that did not authorize copayments.

States that adopted copayments saw ED utilization drop less than one-tenth of 1%, the researchers found. Meanwhile, there was no increase in the rate of Medicaid patients’ visits to primary care providers (PCPs), suggesting patients did not seek primary care in place of the emergency care.

The researchers speculated that the findings may reflect unwillingness among ED providers to deny care to Medicaid patients unable to pay a fee, as well as difficulty they may encounter in determining whether a request for care is truly urgent. Meanwhile, a lack of access to PCPs could be driving Medicaid patients to seek care in EDs.

“The states are hungry for ways to control costs and expand access to care, and copayments are one attractive option,” said the study’s senior author, Craig E. Pollack, MD, associate professor of medicine, Johns Hopkins University School of Medicine. “But unfortunately, this may not be the tool to help accomplish that.”—Jolynn Tumolo

References

Siddiqui M, Roberts ET, Pollack CE. The effect of emergency department copayments for Medicaid beneficiaries following the Deficit Reduction Act of 2005. JAMA Internal Medicine. 2015 January 26. [Epub ahead of print].

Study: even with copayments for nonurgent care, Medicaid patients still rely on ERs [press release]. Johns Hopkins Medicine: Baltimore; January 26, 2015.