2012 Volume 23 Issue 2 Pages 95-106
In the past few years, dozens of large hospitals across Japan have increased the after-hours copayment for their emergency services to discourage the patients with non-urgent conditions and focus on the care of patients with urgent conditions. We studied the effect of the copayment at the emergency department of a large suburban hospital by examining the number of patients before and after the increase in the copayment in April 2008.
We collected data on patients who visited its emergency department before （April and October 2007） and after （April and October 2008） the increase in the copayment. The copayment was set at the minimum of ¥850 to the maximum of ¥4800 according to the time of the visit, but it was waived if the visit was deemed necessary by a physician （e.g., hospitalized after the visit, referred to the emergency department, and visit after a traffic or industrial accident）, the patient was 6 years old or younger, or the patient received public medical assistance. We classified patients by their presumed urgency status into two groups: patients who arrived by ambulances （urgent） versus by other means （non-urgent）; and patients who were hospitalized after the visit （urgent） versus those who were sent home （non-urgent）. We employed Poisson regression analysis to model the number of patients of each status as dependent variables, with the amount of copayment, age, sex, and time of visit as independent variables and person-hours as control variables. Models were selected by Akaike information criteria.
After the increase in the copayment, emergency department use declined by approximately 35% among patients with non-urgent conditions but remained unchanged among patients with urgent conditions. The change was almost consistent across subgroups. Our results suggest that the number of patients with non-urgent conditions could be selectively reduced by increasing the size of copayment.
Further research to examine the possible adverse health effects among the discouraged patients is warranted.
