Télécharger le rapport (152 p.) - KCE

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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
KCE reports vol. 19B Urgences 115 b) Have you ever not gone to ED because you were concerned about paying this amount??(Yes/no). c) Report yourself the cosha for ED-visits, officevisits, drugs.. These data were linked to a database of health profile of the pat.!!! Assessment of changes in a bivariate and multivariate analysis based on demographic, social indicators and medical antecedents. runniong to evaluate the impact of ED copas on clinical outcome, and to study the behavioural changes towards higher levels of copas.
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