Hsu John, Reed Mary, Brand Richard, Fireman Bruce, Newhouse Joseph P, Selby Joseph V
Division of Research, Kaiser Foundation Research Institute, Oakland, CA 94612, USA.
Med Care. 2004 Mar;42(3):290-6. doi: 10.1097/01.mlr.0000114917.50457.52.
The use of cost-sharing to control healthcare expenditures is increasing, but there is scant information about patients' knowledge of cost-sharing or its influence on behavior.
The objective of this study was to evaluate what patients know about their individual levels of cost-sharing and how it influences decisions to seek care.
We conducted a cross-sectional telephone survey with a 69% response rate.
We studied a stratified random sample of 695 adult patients in an integrated delivery system: 266 subjects > or =65 years, 218 low-income subjects, and 211 subjects from the overall membership.
We used perceived and actual levels of copayments for emergency department (ED) visits, office visits, and prescription drugs; and self-reports of copayment-related behavior changes.
One third of subjects correctly reported their ED copayment, whereas three fourths correctly reported their prescription drug and office visit copayments. Over half of the subjects (57%) underestimated their ED copayment by $20 or more. Among patients who reported having any copayment, 11% described changing their behavior because of the copayment, ie, delayed or avoided emergency care. The perceived copayment level was strongly associated with behavior change (odds ratio, 3.9). Other significant factors included having more ED visits in the past 12 months and having a low health status.
Patients have less knowledge of their ED cost-sharing levels than for other services. The perceived copayment amount was strongly associated with avoidance of or delays in emergency care. Further research is needed to determine whether these responses reflect greater efficiency or harmful decisions.
采用费用分担来控制医疗保健支出的情况日益增多，但关于患者对费用分担的了解及其对行为影响的信息却很少。
本研究的目的是评估患者对其个人费用分担水平的了解程度以及这如何影响其就医决策。
我们进行了一项横断面电话调查，回复率为69%。
我们在一个综合医疗服务体系中对695名成年患者进行了分层随机抽样研究：266名年龄≥65岁的受试者，218名低收入受试者，以及211名来自全体会员的受试者。
我们采用了急诊就诊、门诊就诊和处方药的自付费用感知水平和实际水平；以及与自付费用相关行为变化的自我报告。
三分之一的受试者正确报告了其急诊自付费用，而四分之三的受试者正确报告了其处方药和门诊就诊的自付费用。超过一半的受试者（57%）将其急诊自付费用低估了20美元或更多。在报告有任何自付费用的患者中，11%称因自付费用而改变了行为，即推迟或避免了急诊护理。自付费用感知水平与行为改变密切相关（优势比为3.9）。其他显著因素包括在过去12个月内急诊就诊次数较多以及健康状况较差。
患者对急诊费用分担水平的了解低于对其他服务的了解。自付费用感知金额与避免或推迟急诊护理密切相关。需要进一步研究以确定这些反应是否反映了更高的效率或有害的决策。
