title: Self-referred patients at the Emergency Department: patient characteristics, motivations, and willingness to make a copayment.
abstract: BACKGROUND
  In 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  A 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).
  
  
  CONCLUSIONS
  SRPs (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.
authors.affiliation: Department of Emergency Medicine, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: de Valk
authors.affiliation: Department of Emergency Medicine, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands.
authors.forename: Elisabeth M
authors.initials: EM
authors.lastname: Taal
authors.affiliation: Department of Emergency Medicine, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands.
authors.forename: Mariette S
authors.initials: MS
authors.lastname: Nijhoff
authors.affiliation: Department of Emergency Medicine, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands.
authors.forename: Maren H
authors.initials: MH
authors.lastname: Harms
authors.affiliation: Trauma Research Unit, Department of Surgery, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands.
authors.forename: Esther Mm
authors.initials: EM
authors.lastname: Lieshout
authors.affiliation: Department of Emergency Medicine, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Patka
authors.affiliation: Department of Emergency Medicine, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, 3000, CA, The Netherlands.
authors.forename: Pleunie Pm
authors.initials: PP
authors.lastname: Rood
keywords: Copayment; Emergency Department; General Practitioner cooperative; General practitioner; Health services accessibility; Patient motivations; Self-referred patients
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