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