Télécharger le rapport (152 p.) - KCE
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8 Urgences <strong>KCE</strong> reports vol. 19B<br />
Mots clés par question<br />
3.3.2. Inclusion criteria<br />
3.4. RESULTS<br />
Cost-sharing and ED use : cost-sharing, co-payment, co-payment and health<br />
services (PsycInfo), cost-sharing and emergency, copayment and emergency,<br />
forfait en spoedgeval<strong>le</strong>n, emergency and economics,<br />
Determinants of ED use, socio-economic factors of ED use, motivation for<br />
ED use: after-hours care, appointments and schedu<strong>le</strong>s, patient acceptance of<br />
health care, health know<strong>le</strong>dge, attitudes, patient satisfaction, practice<br />
management, continuity of patient care, practice emergency service, hospital,<br />
emergency service/department, , health services misuse, rate setting and<br />
review, emergency service and socio-economic characteristics (PsycInfo),<br />
continuity of patient care (PsycInfo), health care and deprivation (Econlit),<br />
hospital services (Econlit), measuring concentration in primary care (Econlit),<br />
practice management (Econlit), attitudes towards health care (Econlit)<br />
Inappropriate use of ED: inappropriate recourse, health-care misuse, EDattendance,<br />
appropriate use and ED, Emergencies, Family Practice, Health<br />
Services/ut, Health Services Misuse/sn, Attitude of Health Personnel.<br />
Alternatives to ED use: after hours care and emergency, delay and emergency,<br />
quality research and emergency, social security provisions and Europe,<br />
managed care and quality.<br />
Artic<strong>le</strong>s in English, French and Dutch with an abstract were included.<br />
Due to the scarce number of artic<strong>le</strong>s related to the issue of fixed co-payments<br />
( forfait ), cost-sharing and copayment, all types of studies were included. Comparative<br />
studies between primary care and emergency department care in Belgium and the<br />
Netherlands, and the most recent national health survey in Belgium were consulted on<br />
the equity issue of emergency care 8, 9 .<br />
Parmi <strong>le</strong>s études relatives aux caractéristiques socio-économiques des patients<br />
recourant aux services dÊurgence, ont été exclues <strong>le</strong>s études quantitatives sÊadressant à<br />
des sous-populations spécifiques (sans domici<strong>le</strong> fixe, toxicomanes).<br />
The search in the literature databases only provided very limited research on the effects<br />
of cost-sharing on emergency department use. Moreover, the results show a c<strong>le</strong>ar bias<br />
towards American studies. For the North-American studies not a sing<strong>le</strong> study was<br />
found, considering the lowest socio-economic category, falling outside the American<br />
insurance system.<br />
Limited references are found about research in European countries. Reading through<br />
the findings one should therefore continuously take into account the different welfare<br />
contexts and health insurance systems.<br />
Furthermore, it is very c<strong>le</strong>ar that the studies are not providing high <strong>le</strong>vels of evidence.<br />
Most published research gives only indications of effects on consultation behaviour, and<br />
discusses specific equity issues.<br />
3.4.1. Studies on effects of cost-sharing measures on the use of emergency<br />
departments<br />
USA<br />
Hsu et al. 10 evaluated through a cross-sectional te<strong>le</strong>phone survey what patients know<br />
about their individual <strong>le</strong>vels of co-payment and how it influences their decisions to seek<br />
care. After adjustment for socioeconomic and demographic factors, the authors found<br />
that 20% of subjects who thought their co-payment was $20 or higher said they had