Newacheck P W, Brindis C D, Cart C U, Marchi K, Irwin C E
Institute for Health Policy Studies, University of California, San Francisco, California, USA.
Pediatrics. 1999 Aug;104(2 Pt 1):195-202. doi: 10.1542/peds.104.2.195.
To assess the health insurance status of adolescents, the trends in adolescent health care coverage, the demographic and socioeconomic correlates of insurance coverage, and the role that insurance coverage plays in influencing access to and use of health care. Together, the results provide a current and comprehensive profile of adolescent health insurance coverage.
We analyzed data on 14 252 adolescents, ages 10 to 18 years, included in the 1995 National Health Interview Survey. The survey obtained information on insurance coverage and several measures of access and utilization, including usual source of care, site of the usual source of care, indications of missed or delayed care, and use of ambulatory physician services by adolescents. We conducted multivariate analyses to assess the independent association of age, sex, race, poverty status, family structure, family size, region of residence, metropolitan resident status, and health status on the likelihood of insurance coverage. We conducted bivariate and multivariate analyses to ascertain how insurance coverage was related to each of the access and utilization measures obtained in the survey. We also examined trends in health insurance coverage using the 1984, 1989, and 1995 editions of the National Health Interview Survey.
An estimated 14.1% of adolescents were uninsured in 1995. Risk of being uninsured was higher for older adolescents, minorities, adolescents in low-income families, and adolescents in single parent households. Compared with their insured counterparts, uninsured adolescents were five times as likely to lack a usual source of care, four times as likely to have unmet health needs, and twice as likely to go without a physician contact during the course of a year. Between 1984 and 1995 the percentage of adolescents with some form of health insurance coverage remained essentially unchanged. During this period, the prevalence of private health insurance decreased, while the prevalence of public health insurance increased.
This study demonstrates the critical importance of health insurance as a determinant of access to and use of health services among adolescents. It also shows that little progress has been made during the past 15 years in reducing the size of the uninsured adolescent population. The new State Children's Health Insurance Program could lead to substantial improvements in access to care for adolescents, but only if states implement effective outreach and enrollment strategies for uninsured adolescents.adolescents, health insurance, access, Medicaid, SCHIP.
评估青少年的健康保险状况、青少年医疗保健覆盖范围的趋势、保险覆盖范围的人口统计学和社会经济相关因素，以及保险覆盖范围在影响医疗保健获取和使用方面所起的作用。这些结果共同提供了青少年健康保险覆盖范围的当前综合概况。
我们分析了1995年全国健康访谈调查中纳入的14252名10至18岁青少年的数据。该调查获取了有关保险覆盖范围以及若干获取和利用指标的信息，包括通常的医疗保健来源、通常医疗保健来源的地点、错过或延迟医疗保健的迹象，以及青少年使用门诊医生服务的情况。我们进行了多变量分析，以评估年龄、性别、种族、贫困状况、家庭结构、家庭规模、居住地区、大都市居住状况和健康状况与保险覆盖可能性之间的独立关联。我们进行了双变量和多变量分析，以确定保险覆盖范围与调查中获得的每项获取和利用指标之间的关系。我们还利用1984年、1989年和1995年版的全国健康访谈调查研究了健康保险覆盖范围的趋势。
1995年估计有14.1%的青少年未参保。年龄较大的青少年、少数族裔青少年、低收入家庭青少年和单亲家庭青少年未参保的风险更高。与参保的青少年相比，未参保的青少年缺乏通常医疗保健来源的可能性高五倍，有未满足的健康需求的可能性高四倍，一年中未看医生的可能性高两倍。1984年至1995年期间，有某种形式健康保险覆盖的青少年比例基本保持不变。在此期间，私人健康保险的普及率下降，而公共健康保险的普及率上升。
本研究表明健康保险作为青少年获得和使用医疗服务的决定因素至关重要。它还表明，在过去15年中，在减少未参保青少年人口规模方面进展甚微。新的州儿童健康保险计划可能会大幅改善青少年获得医疗服务的机会，但前提是各州为未参保青少年实施有效的宣传和参保策略。青少年、健康保险、获取、医疗补助、儿童健康保险计划。
