Care-seeking behavior in response to emergency department copayments.
BACKGROUND
Patients are increasingly paying for more of their medical care through cost-sharing, yet little is known about how patients change the ways that they seek care in response.


OBJECTIVE
We sought to assess how patients change their care-seeking behavior in response to emergency department (ED) copayments.


METHODS
Telephone interviews with a stratified random sample of adult members of a large integrated delivery system.


METHODS
There were 932 respondents (72% response rate).


METHODS
We examined participants' knowledge of their copayment level for ED services, and measures of how the cost-sharing affected their decisions about where or when to seek care.


RESULTS
Overall, 82% of participants faced a copayment for ED services (ranging between 5 US dollars and 100 US dollars), and 41% correctly reported the amount of this copayment. In response to the perceived copayment amount, 19% reported changing their care-seeking behavior within the previous 12 months: 12% sought care from an alternate delivery site, 12% contacted a provider by telephone or the Internet, 9% delayed going to the ED, and 2% avoided medical care altogether. In multivariate models, the ED cost-sharing amount was significantly associated with reporting changes in care-seeking behavior.


CONCLUSIONS
When faced with an ED copayment, patients in the health system most commonly shifted toward seeking care from other available alternatives, and rarely avoid medical care altogether.
Reed
Mary
M
Division of Research, Kaiser Permanente Medical Care Program, Oakland, California 94612, USA.
Fung
Vicki
V
Brand
Richard
R
Fireman
Bruce
B
Newhouse
Joseph P
JP
Selby
Joseph V
JV
Hsu
John
J
D000328:Adult; D000368:Aged; D002140:California; D017047:Cost Sharing / Q000191:economics / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007182:Income; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010548:Personal Health Services / Q000191:economics*