Télécharger le rapport (152 p.) - KCE
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Télécharger le rapport (152 p.) - KCE
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116 Urgences <strong>KCE</strong> reports vol. 19B<br />
Publication<br />
Data<br />
Shapiro M.F.<br />
et al-Annals<br />
of internal<br />
med.-1986-<br />
104:246-<br />
251.USA-<br />
California.<br />
MESH-terms Objective Planning Conclusion Material/Methods Results / Comments Comments/Discussion<br />
Cosha and<br />
seeking care<br />
for<br />
minor(min.)<br />
and<br />
major(maj.)<br />
symptoms.<br />
Better<br />
understanding<br />
how cosha<br />
achieves<br />
reductions in<br />
medical<br />
expenditures in<br />
the fee-forservice<br />
system .<br />
This is analysed<br />
through an<br />
estimation of<br />
cosha on adults<br />
seeking care<br />
with 2 different<br />
clusters of<br />
symptoms.(min.<br />
and maj.)<br />
Randomsampling<br />
among freecare<br />
and<br />
copa-pat.<br />
Matched<br />
among two<br />
clusters of<br />
symptoms.<br />
Prospective(<br />
?)<br />
Cosha is an<br />
effective policy<br />
for reducing<br />
medical<br />
expenditures.<br />
However there<br />
may be some<br />
se<strong>le</strong>ctivity in<br />
how these<br />
reductions are<br />
se<strong>le</strong>ctively<br />
perceived and<br />
achieved by pat.<br />
in seeking care<br />
for minor or<br />
major<br />
symptoms.<br />
However the<br />
study results<br />
suggest there<br />
may be health<br />
consequences<br />
not equally<br />
shared by<br />
different <strong>le</strong>vels<br />
of income and<br />
livelihood.(!!!)<br />
Analysis(regression model)<br />
of 3539 pers. Of 6 areas in<br />
California. Exclusion of<br />
elderly and Medicaid<br />
affiliated and candidates-<br />
Families assigned to 1 of 13<br />
insurance plans from free<br />
care to cosha-<strong>le</strong>vels. Max.<br />
of pocket expenses of 1000<br />
usd:year.<br />
Inventory of 27 symptoms,<br />
linked to time within the<br />
month before and a<br />
subsequent or not to a<br />
physician.<br />
2 clusters of min. and maj.<br />
sy. Identified by<br />
a) recordings from a grp. of<br />
9 independent MD, and<br />
from pat. in 2 cat.(16-<br />
44,45-64 yrs) of the<br />
seriousness of the<br />
symptoms(MD) and the<br />
consult of a MD(pat).<br />
This records were sca<strong>le</strong>d.<br />
b) Impact of each sy by pat.<br />
themselves. was estimated<br />
on IHE data on the general<br />
health rating index(GHRI).<br />
o Results= 2 clusters.<br />
o The first are minor<br />
No basic differences<br />
between the free and coshapat.<br />
in rates of seeking care<br />
for both min. and maj. sy.<br />
And even not in the<br />
preva<strong>le</strong>nce of these sy.<br />
*Serious sy. were reported<br />
more frequently during the<br />
study period by cosha pat.<br />
than by free-care pat.(p<<br />
0,05).<br />
*In the lowest 40% grp of<br />
both social and health status<br />
the preva<strong>le</strong>nce of serious sy.<br />
was higher among the cosha<br />
than the free care pat.(p<<br />
0,004). This tendency<br />
remains during the who<strong>le</strong><br />
study period. This was not<br />
the case in the higher social<br />
and health statusgrp.<br />
*Cosha-pat. were <strong>le</strong>ss likely<br />
to consult a MD for minor<br />
sy. than free-care pat.(p<<br />
0,03). No difference for<br />
serious sy.<br />
*Statistical tests didnÊt<br />
support that the seeking for<br />
care differed in social, health<br />
and site categories.<br />
This study was mainly<br />
focused on the impact of<br />
cost-sharing on the reduction<br />
of medical expenditures(in a<br />
fee-for-service syst.) coping<br />
with two diffrent clusters of<br />
symptoms.<br />
This clusters, serious and<br />
minor symptoms were rated<br />
by a grp of independent<br />
physicians and related to the<br />
pat. perceptions of their<br />
health.(Global health-rating<br />
system: this index gives a<br />
good overall review of the<br />
health-status of a given<br />
population).<br />
The difference of the plans in<br />
the preva<strong>le</strong>nce of sy. was<br />
only significant in the grp. In<br />
the lowest 40 % of both<br />
socioeconomic and healthstatus<br />
at the start of the<br />
experiment.(more preva<strong>le</strong>nce<br />
in the coshas than in the<br />
free-carepat.).<br />
The study records a 30%<br />
reduction in phys. Visits for<br />
the cosha-grp. Relative to the<br />
free-caregrp., in relation to<br />
minor symptoms. In contrast<br />
the studiers didnÊt see any<br />
significant difference for phys.<br />
visits in relation to serious