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Background The requirement of copayments for emergency care is thought to control costs by reducing "inappropriate" visits to the emergency department. However, requiring copayments may lead to adverse outcomes if patients delay seeking care for emergency conditions. To determine whether such requirements are associated with delays in seeking care, we examined the length of time from the onset of symptoms to arrival at the hospital among patients with myocardial infarction who did or did not have required insurance copayments.
Methods All patients were enrolled in a single health maintenance organization (HMO) and presented with myocardial infarction at 1 of 19 hospitals in King County, Washington, from 1989 through 1994. There were 602 patients whose health insurance required a copayment for emergency department care (range, $25 to $100) and 729 patients with no copayment requirement. Data on the time to presentation were obtained from a review of ambulance and hospital records.
Results The median length of time from the onset of symptoms to arrival at the hospital, as adjusted for age, sex, and race, was 135 minutes for the copayment group and 137 minutes for the group with no copayment (95 percent confidence interval for the difference, -19 to +16 minutes). There was no significant association between the presence or absence of a copayment requirement and the time to arrival at the hospital after adjustment for calendar year, income, educational level, cardiac history, or clinical symptoms. Since some patients may be unaware of their copayment requirement, we performed a subgroup analysis of data on patients who had a previous visit to the emergency department with the same copayment status — that is, of patients who were likely to know about their copayment. This analysis also showed no significant association between the requirement for a copayment and delays in seeking treatment.
Conclusions For privately insured patients in this HMO, the requirement of modest, fixed copayments for emergency services did not lead to delays in seeking treatment for myocardial infarction.
Source Information
From the Clinical Research Unit, Colorado Permanente Medical Group, Denver (D.J.M.); the Department of Preventive Medicine and Biometrics and the Division of Emergency Medicine, University of Colorado Health Sciences Center, Denver (D.J.M.); the Robert Wood Johnson Clinical Scholars Program (D.J.M., T.D.K.), the Departments of Epidemiology (T.D.K., D.S.S.), Health Services (T.D.K., E.H.W.), Medicine (T.D.K., N.R.E., J.S.M., D.S.S.), and Cardiology (N.R.E., J.S.M.), University of Washington, Seattle; the Northwest Health Services Research and Development Field Program, Seattle Veterans Affairs Medical Center, Seattle (N.R.E.); the Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle (E.H.W.); and the Division of Cardiovascular Medicine and the Heart and Vascular Institute, Henry Ford Health System, Detroit (W.D.W.). The views, opinions, and conclusions in this article are those of the authors and not necessarily those of the Robert Wood Johnson Foundation.
Address reprint requests to Dr. Magid at the Clinical Research Unit, Colorado Permanente Medical Group, 10350 E. Dakota Ave., Denver, CO 80231-1314.
Related Letters:
Insurance Copayments and Delays in Seeking Emergency Care
Soumerai S. B., Ross-Degnan D., Taylor J. M., Magid D. J., Koepsell T. D., Wagner E. H., Weaver W. D.
Extract |
Full Text
N Engl J Med 1997;
337:1247-1248, Oct 23, 1997.
Correspondence
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