Télécharger le rapport (152 p.) - KCE
Télécharger le rapport (152 p.) - KCE
Télécharger le rapport (152 p.) - KCE
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
114 Urgences <strong>KCE</strong> reports vol. 19B<br />
Publication<br />
Data<br />
Hsu et<br />
al(SelbyJV)-<br />
Med.Care<br />
2004(42;39<br />
0-396)<br />
USA-<br />
California.<br />
MESH-terms Objective Planning Conclusion Material/Methods Results / Comments Comments/Discussion<br />
Cost sharing<br />
(cosha-copa)<br />
and<br />
know<strong>le</strong>dge.(k<br />
n<strong>le</strong>dge)<br />
Evaluation of<br />
the kn<strong>le</strong>dge of<br />
pat. about theit<br />
<strong>le</strong>vels of cosha<br />
and how it<br />
influences<br />
decisions to<br />
seek care<br />
Crosssectional.<br />
Randomly<br />
stratified.<br />
Patients have<br />
<strong>le</strong>ss kn<strong>le</strong>dge of<br />
their ED cosha<br />
<strong>le</strong>vels than for<br />
other services.<br />
Cross-sect. Tel.survey with<br />
a 69 % response rate(695<br />
adults, pop.of 2,7 million,<br />
1/3 > 65 yrs).<br />
Random se<strong>le</strong>ction for 3<br />
member strata: overall<br />
membership, memb. > 65<br />
yrs, memb. With annual<br />
household income of <strong>le</strong>ss <<br />
35000 Usd. In an integrated<br />
health delivery<br />
system.(KNPC)<br />
On 1-1-2000 KNPC<br />
increased ED-copa for half<br />
of its members :20Usd/visit<br />
or more., negociated with<br />
employers.<br />
Exclusion of < 18 and<br />
Medicaidpat.<br />
Premailing for participation.<br />
20 min/ interview.<br />
o Question ex.(for our<br />
study)<br />
a) how often have you<br />
delayed going to the<br />
ED because you have<br />
were enrol<strong>le</strong>d about<br />
paying this amount of<br />
cosha.(5-p. Likert<br />
sca<strong>le</strong>).??<br />
Demographic characteristics:<br />
Majority of incomes< 35000<br />
Usd.<br />
20 % report having an Edvisit<br />
in the past 12 months.<br />
97% of these have a same<br />
cosha-<strong>le</strong>vel.<br />
Cosha kn<strong>le</strong>dge:<br />
33 % reported correctly<br />
their cosha.<br />
57 % underestimated their<br />
actual amounts.<br />
No significant differences in<br />
the kn<strong>le</strong>dge of amounts<br />
among the 3 strata pat.<br />
More current report of<br />
office visits and drugs.<br />
3/4 of the pat. with 2 or<br />
more visits of ED in the past<br />
123 months had correct<br />
perceptions of coshas.(> 20<br />
or not)<br />
No statistical differences in<br />
the relationship between<br />
perceived copas and<br />
behavioural changes by<br />
income or ED visits in the<br />
past 12 months.<br />
This is the first study to<br />
assess directly the pat.<br />
kn<strong>le</strong>dge of cosha structures<br />
and compare perceived<br />
amounts with change in<br />
behaviopr, also specifically<br />
for ED-use.<br />
Pat. donÊt know very much<br />
about a copa in ED or mental<br />
health, more about office<br />
visits and drugs.(cfr. RAND<br />
and Marquis et al-nr 12 ref).<br />
Perceived amount of copa<br />
was strongly associated with<br />
self-reported delay or<br />
avoidance in ED-care.(> 20%<br />
cosha: 20%; < 20 %cosha 6<br />
%).<br />
Other studies(Selby, Marquis,<br />
Nelson) complied with these<br />
findings and the RAND HEI<br />
showed a significant<br />
difference between free-care<br />
users( 42 % more expenses)<br />
and copas.<br />
Limitation of this study is the<br />
lack of studied information<br />
about the perceived need for<br />
care and the alternative<br />
sources of care. Hence the<br />
factor appropriate-non<br />
appropriate cannot be<br />
included. A new study is now