Long S H, Marquis M S
RAND, Washington, DC 20005-4707, USA.
JAMA. 1999 Jun 2;281(21):2035-40. doi: 10.1001/jama.281.21.2035.
Although an extensive literature exists comparing national access to health care for uninsured vs insured children, few data exist regarding differences in access across states.
To examine variation in access to physician services for uninsured children in 10 states, the safety net's role in explaining this variation, and the potential effects of the State Children's Health Insurance Program (CHIP) on insurance coverage and access.
The population-based Robert Wood Johnson Foundation Family Health Insurance Survey, conducted between summer 1993 and spring 1994 in 10 states (Colorado, Florida, Minnesota, New Mexico, New York, North Dakota, Oklahoma, Oregon, Vermont, and Washington), with a response rate of families by state ranging from 61% to 83%.
A total of 8565 children who were uninsured (1586), covered by Medicaid (2723), or covered by employer-sponsored private insurance (4256) for 1 full year prior to the survey.
Percentage of low-income children who are uninsured and predicted annual physician visits by state if insurance was provided to uninsured children in families with incomes of less than 200% of poverty level.
In the 10 study states, low-income children ranged from 61% to 86% of all uninsured children and the uninsured rate for low-income children varied from 9% to 31%. On average, providing public coverage would increase annual physician visits from 2.3 to 4.6 (a 105% increase), but the increase would range from 41% to 189% across states. The annual physician visit rate in the 3 states with the highest access for the uninsured was 160% of that in the 3 lowest-access states. Safety net capacity in the high-access states ranged from 120% to 220% of that in the low-access states.
Our data suggest that the potential effects of CHIP vary substantially across states. Notably, improvements in access to health care by uninsured low-income children should be greater in states with the fewest safety net resources.
尽管存在大量比较未参保儿童与参保儿童获得国家医疗保健服务情况的文献，但关于各州之间获得医疗服务的差异的数据却很少。
研究10个州中未参保儿童获得医生服务的差异、安全网在解释这种差异中所起的作用，以及儿童健康保险计划（CHIP）对保险覆盖范围和获得医疗服务机会的潜在影响。
基于人群的罗伯特·伍德·约翰逊基金会家庭健康保险调查，于1993年夏季至1994年春季在10个州（科罗拉多州、佛罗里达州、明尼苏达州、新墨西哥州、纽约州、北达科他州、俄克拉何马州、俄勒冈州、佛蒙特州和华盛顿州）进行，各州家庭的回复率在61%至83%之间。
共有8565名儿童，在调查前的一整年中，他们未参保（1586名）、参加了医疗补助计划（2723名）或参加了雇主赞助的私人保险（4256名）。
未参保的低收入儿童的比例，以及如果为收入低于贫困线200%的家庭中的未参保儿童提供保险，按州预测的年度医生就诊次数。
在10个研究州中，低收入儿童占所有未参保儿童的比例从61%到86%不等，低收入儿童的未参保率从9%到31%不等。平均而言，提供公共保险将使年度医生就诊次数从2.3次增加到4.6次（增加105%），但各州的增幅从41%到189%不等。未参保儿童获得医疗服务机会最高的3个州的年度医生就诊率是获得医疗服务机会最低的3个州的160%。高获得医疗服务机会州的安全网能力是低获得医疗服务机会州的120%至220%。
我们的数据表明，儿童健康保险计划的潜在影响在各州之间有很大差异。值得注意的是，在安全网资源最少的州，未参保的低收入儿童获得医疗服务的改善应该更大。
