title: Introducing copayments in the emergency department would deter appropriate visits in the Netherlands.
abstract: OBJECTIVE
  To determine what the effects of introduction of copayments for self-referred emergency department (ED) visits would be in the Netherlands and at what amount patients would turn to a GP before visiting an ED.
  
  
  METHODS
  This questionnaire study was carried out in the ED of the Rijnstate Hospital, a community teaching hospital in the Netherlands. In the Netherlands, a deductible excess system is in use and this study investigated the effects of a copayment for self-referred patients (SRPs) on top of the deductible excess. A questionnaire was developed and handed out to SRPs.
  
  
  RESULTS
  A total of 433 SRPs were included; their average age was 33.1 years and 63% were male. With a copayment of &OV0556;100, 47% of SRPs would choose to visit their GP instead of the ED. A further increase in the copayment amount is largely ineffective in reducing the number of self-referred ED visits. The higher the household income and education level and the more urgent the triage category, the larger the copayment patients are willing to pay. There is no significant relation between appropriateness and the amount of copayment that patients are willing to pay and we found no specific copayment level that resulted in reducing mainly inappropriate ED visits.
  
  
  CONCLUSIONS
  With a copayment of &OV0556;100, 47% of the SRPs would choose to visit their GP instead of the ED. There was no specific copayment level that resulted in reducing mainly inappropriate ED visits.
authors.affiliation: Emergency Department.
authors.forename: Nicole
authors.initials: N
authors.lastname: Kraaijvanger
authors.affiliation: Emergency Department.
authors.forename: Douwe
authors.initials: D
authors.lastname: Rijpsma
authors.affiliation: Intensive Care.|Internal Medicine, Rijnstate Hospital, Arnhem.
authors.forename: Henk
authors.initials: H
authors.lastname: van Leeuwen
authors.affiliation: Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Michael
authors.initials: M
authors.lastname: Edwards
mesh_terms: D017047:Cost Sharing; D003669:Deductibles and Coinsurance; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D058006:General Practice / Q000193:education*; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D007362:Intensive Care Units / Q000191:economics; D008297:Male; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*