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