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8 Urgences KCE reports vol. 19B
Mots clés par question
3.3.2. Inclusion criteria
3.4. RESULTS
Cost-sharing and ED use : cost-sharing, co-payment, co-payment and health
services (PsycInfo), cost-sharing and emergency, copayment and emergency,
forfait en spoedgevallen, emergency and economics,
Determinants of ED use, socio-economic factors of ED use, motivation for
ED use: after-hours care, appointments and schedules, patient acceptance of
health care, health knowledge, attitudes, patient satisfaction, practice
management, continuity of patient care, practice emergency service, hospital,
emergency service/department, , health services misuse, rate setting and
review, emergency service and socio-economic characteristics (PsycInfo),
continuity of patient care (PsycInfo), health care and deprivation (Econlit),
hospital services (Econlit), measuring concentration in primary care (Econlit),
practice management (Econlit), attitudes towards health care (Econlit)
Inappropriate use of ED: inappropriate recourse, health-care misuse, EDattendance,
appropriate use and ED, Emergencies, Family Practice, Health
Services/ut, Health Services Misuse/sn, Attitude of Health Personnel.
Alternatives to ED use: after hours care and emergency, delay and emergency,
quality research and emergency, social security provisions and Europe,
managed care and quality.
Articles in English, French and Dutch with an abstract were included.
Due to the scarce number of articles related to the issue of fixed co-payments
( forfait ), cost-sharing and copayment, all types of studies were included. Comparative
studies between primary care and emergency department care in Belgium and the
Netherlands, and the most recent national health survey in Belgium were consulted on
the equity issue of emergency care 8, 9 .
Parmi les études relatives aux caractéristiques socio-économiques des patients
recourant aux services dÊurgence, ont été exclues les études quantitatives sÊadressant à
des sous-populations spécifiques (sans domicile fixe, toxicomanes).
The search in the literature databases only provided very limited research on the effects
of cost-sharing on emergency department use. Moreover, the results show a clear bias
towards American studies. For the North-American studies not a single study was
found, considering the lowest socio-economic category, falling outside the American
insurance system.
Limited references are found about research in European countries. Reading through
the findings one should therefore continuously take into account the different welfare
contexts and health insurance systems.
Furthermore, it is very clear that the studies are not providing high levels of evidence.
Most published research gives only indications of effects on consultation behaviour, and
discusses specific equity issues.
3.4.1. Studies on effects of cost-sharing measures on the use of emergency
departments
USA
Hsu et al. 10 evaluated through a cross-sectional telephone survey what patients know
about their individual levels of co-payment and how it influences their decisions to seek
care. After adjustment for socioeconomic and demographic factors, the authors found
that 20% of subjects who thought their co-payment was $20 or higher said they had