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Cost sharing: (l) Copays for nonemergent emergency department visits, Medicaid adult population

Healthcare: Healthcare System Efficiency
  Literature review updated November 2015.

Evaluations of health care policies and programs often measure two broad types of outcomes: (1) those that reflect the health status of people (e.g., disease incidence) and (2) those that reflect health care system costs and utilization. Cost and utilization measures may or may not be an indication of health status or well-being.

The effect reported below is for implementation of modest copays (in the range of $3 to $15) for emergency department visits that are judged not to be emergent (in these cases, a hospital determines, after an appropriate medical screening, that the individual does not need emergency medical services). These copays have been implemented by some state Medicaid programs.
 
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META-ANALYSIS
CITATIONS

*The effect size for this outcome indicates percentage change, not a standardized mean difference effect size.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the program impacts measured in the research literature (for example, impacts on crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information on how we estimate effect sizes.

The effect size may be adjusted from the unadjusted effect size estimated in the meta-analysis. Historically, WSIPP adjusted effect sizes to some programs based on the methodological characteristics of the study. For programs reviewed in 2024 or later, we do not make additional adjustments, and we use the unadjusted effect size whenever we run a benefit-cost analysis.

Research shows the magnitude of effects may change over time. For those effect sizes, we estimate outcome-based adjustments, which we apply between the first time ES is estimated and the second time ES is estimated. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured No. of effect sizes Treatment N Effect sizes (ES) and standard errors (SE) Unadjusted effect size (random effects model)
ES SE Age ES p-value
Emergency department visits*
Whether someone visited the emergency department, or the number of times they visited the emergency department.
0 2 21074 0.031 0.064 40 0.031 0.630

Citations Used in the Meta-Analysis

Mortensen, K. (2010). Copayments did not reduce medicaid enrollees' nonemergency use of emergency departments. Health Affairs (project Hope), 29(9), 1643-50.

Siddiqui, M., Roberts, E.T., & Pollack, C.E. (2015). The effect of emergency department copayments for Medicaid beneficiaries following the Deficit Reduction Act of 2005. Jama Internal Medicine, 175(3), 393-8.