Co-payments for emergency department visits: a quasi-experimental study

Financial recession in Cyprus has led to health reforms to promote efficiency and reduce public expenditure. In this context, a co-payment fee was introduced in 2013 for all emergency department (ED) visits, with the aim of reducing potentially avoidable visits. The objective of this study was to assess the short-term intended and unintended impacts of introducing these co-payments.

The study design is an interrupted time series analysis.

We used an autoregressive integrated moving average model for interrupted time series analysis of data on ED visits over 42 consecutive months, from 2013 to 2015 in a regional hospital in Cyprus. The ED visits have been classified to non-avoidable and potentially avoidable visits.

The introduction of co-payment had no effect on non-avoidable visits (4% [95% confidence interval {CI}: 4.3–11.08] P = 0.694). However, it had the immediate and sustained effect of reducing potentially avoidable visits, an effect that was statistically significant from the first month onwards (29.8% [95% CI: 22.6–34.1] P < 0.00001).

Co-payments can be a valuable tool for reducing potentially avoidable emergency department visits, without adversely impacting non-avoidable visits. This is a particularly significant finding for countries experiencing financial pressures and struggling to reduce waste in health expenditure. However, the long-term impact of this policy must be assessed, including potential negative effects on public health, to make sure it does not create barriers in obtaining necessary health care that might actually increase expenses in the long run. In particular, timely access to primary care services must be safeguarded.