SECTION7. EMPLOYEECOSTSHARING HOSPITALADMISSIONS,OUTPATIENTSURGERYANDEMERGENCYROOMVISITS • Whetherornotaworkerhasageneralannualdeductible,mostworkersfaceadditionaltypesofcostsharing(such asacopayment,coinsurance,oraperdiemcharge)whenadmittedtoahospitalorhavingoutpatientsurgery. The distribution of workers with cost sharing for hospital admissions, outpatient surgery and emergency roomvisits doesnotequal100%asworkersmayfaceacombinationoftypesofcostsharing. Insomecases,thesecost-sharing arrangementsareverycomplicated;forexampleworkersvisitinganemergencyroommayhavesomeformsof cost-sharingwaivediftheyareadmittedtothehospitalbutstillfaceothercost-sharing. Inaddition,theaverage copaymentandcoinsuranceratesincludeworkerswhomayhaveacombinationofthesetypesofcostsharing. • Beginningthisyear,toreduceburdenonrespondents,werevisedthesurveytoaskrespondentsaboutcostsharingfor inpatient admissions, outpatient surgery and emergencyroomvisitsonlyintheirlargesthealthplantype;previously,we askedforthisinformationforthelargestplanforeachoftheplantypesthattheyoffered. Afterreviewingtheresponses andcomparingthemtoprioryearswhereweaskedabouteachplantype,wefindthattheinformationwearereceiving is quite similar to responses from previous years. For this reason, we will continue to report our results for these questionsweightedbythenumberofcoveredworkersintherespondingfirms. Thereisamoredetaileddiscussionin thesurveydesignandmethodssectiononthistopic. • Forhospitaladmissions,64%ofcoveredworkershavecoinsuranceand12%havecopayments. Lowerpercentages of workershaveperday(perdiem)payments(10%),aseparatehospitaldeductible(1%),orbothacopaymentand coinsurance(6%),while17%havenoadditionalcostsharingforhospitaladmissionsafteranygeneralannualdeductible hasbeenmet[Figure7.28]. – ForcoveredworkersinHMOplans,copaymentsaremorecommon(38%)andcoinsurance(28%)islesscommon thantheaverageforallcoveredworkers[Figure7.28]. – HDHP/SOs,onaverage,haveadifferentcost-sharingstructurethanotherplantypesforhospitaladmissions. Only The Kaiser Family Foundation and Health Research & Educational Trust / Page 118