Copays Have Little Impact On Medicaid Non-Emergency ED Use
By Christine Kern, contributing writer
The data mined from one study reveals there is no increase in the rate of Medicaid patients’ visits to doctors’ offices.
A Johns Hopkins’ study published by JAMA Internal Medicine investigated the rate of Medicaid non-urgent care in emergency departments between 2001 and 2010 across eight states were hospitals were authorized to charge copayments. The study found cost-sharing had no measurable impact on the rate of ED visits.
“As states are expanding Medicaid, they are looking for ways to control costs,” lead author Mona Siddiqui, M.D., M.P.H., an assistant professor of internal medicine at the Johns Hopkins University School of Medicine told Science Daily. “Our study suggests they will need to look at other strategies besides requiring copayments. There was little evidence that cost-sharing would have any impact on the use of emergency rooms by poor people, who often have few other health care options.”
The copay states were compared with 10 states with zero ED copayments (control states). The study included individuals 19 to 64 years old enrolled in Medicaid for a full calendar year as collected by the Medical Expenditure Panel Survey, a nationally representative survey of noninstitutionalized civilians. The sample consisted of 3,122 adult Medicaid recipients in copayment states and 7,433 adult Medicaid recipients in control states.
According to Health Leaders Media, in 2005, Congress authorized ED as part of the Deficit Reduction Act in an effort to match Medicaid patients to more cost-efficient venues of care. Researchers sampled about 3,000 Medicaid patients in Florida, Kentucky, Minnesota, Montana, Ohio, Pennsylvania, South Carolina, and Washington, that charged copayments of $3 to $15 for non-urgent ED visits.
The researchers found the states with the highest initial rates of emergency room use were the most likely to institute copayments from Medicaid recipients for non-urgent care. However, copays resulted in less than a one-tenth of 1 percent decrease in ED use rates, and there was no corresponding increase in the rate of Medicaid patients' visits to doctors' offices, suggesting they were not switching away from the emergency room and toward primary care physicians.
“With respect to this particular study, we can say that cost-sharing in the ED did not have an impact and that has implications for how cost-sharing is approached in Medicaid moving forward,” says study lead author Mona Siddiqui, MD, MPH, assistant professor of internal medicine at the Johns Hopkins University School of Medicine.
According to Senior author Craig E. Pollack, M.D., M.P.H. , an associate professor of medicine at the Johns Hopkins University School of Medicine and an expert in health services research, the results of the study possibly reflect the reluctance on the part of some hospital staff members to deny care in cases where Medicaid patients can't make the copayments. There also may be confusion in identifying which cases qualify as true emergencies.
“The question of whether a need for care is urgent or not is a difficult one, for patients and clinicians,” Pollack said, adding that a lack of access to primary care physicians may be one reason why Medicaid patients continue to seek emergency room care in spite of copayments. The states are hungry for ways to control costs and expand access to care, and copayments are one attractive option. But unfortunately, this may not be the tool to help accomplish that.”