McCormick M C, Weinick R M, Elixhauser A, Stagnitti M N, Thompson J, Simpson L
Harvard Center for Children's Health, Department of Matenal and Child Health, Harvard School of Public Health, Boston, MA 02115, USA.
Ambul Pediatr. 2001 Jan-Feb;1(1):3-15. doi: 10.1367/1539-4409(2001)001<0003:aroata>2.0.co;2.
This report provides an update on insurance coverage, use of health care services, and health expenditures for children and youth in the United States. In addition, the report provides information on variation in hospitalizations for children from a new 22-state hospital discharge data source.
The data on insurance coverage, utilization, and expenditures come from the Medical Expenditure Panel Survey. The data on hospitalizations come from the Database for Pediatric Studies, which is part of the Healthcare Cost and Utilization Project. Both data sets have been prepared by the Agency for Healthcare Research and Quality.
Few changes in insurance coverage occurred between 1996 and 1998. About two thirds of American children are covered by private insurance and 19% by public sources; the remaining 15% are uninsured. Of the 71.5% of children who have at least 1 doctor's office visit, the average number of visits was 3.9, but this ranged from 2.7 among the uninsured to 4.2 for those with private insurance. Slightly more than half of children had a prescription, and these averaged 5.4 prescriptions. The majority of children (85%) incur medical expenditures, averaging $1019 for children with any expenditure. Private health insurance was by far the largest payer of medical care expenses for children, even more so than among the general population. However, nearly 21% of expenditures for children's health care were paid out of pocket by children's families. The data also show substantial differences in average length of hospitalization across states, ranging from 2.7 to 4.0 days, and rates of hospital admission through the emergency department, which vary across states from 9% to 23%. Injuries are a major reason for hospitalization, accounting for 1 in 6 hospital stays among 10- to 14-year-olds. In the 10-17 age group, 1 in 7 hospital stays are due to mental disorders. Among 15- to 17-year-olds, more than one third of all hospital stays are related to childbirth and pregnancy.
Children's use of health care services varies considerably by what type of health insurance coverage they have. Expenditures for children entail a substantial out-of-pocket component, which may be quite large for children with major health problems and which may represent a significant burden on lower-income families. Substantial variation in hospitalization exits across states.
本报告提供了美国儿童和青少年的保险覆盖情况、医疗服务使用情况及医疗支出的最新信息。此外，该报告还依据一个涵盖22个州的新的医院出院数据源，提供了儿童住院情况差异的相关信息。
保险覆盖、利用情况及支出的数据来自医疗支出面板调查。住院数据来自儿科研究数据库，该数据库是医疗成本和利用项目的一部分。这两个数据集均由医疗保健研究与质量局编制。
1996年至1998年间，保险覆盖情况变化不大。约三分之二的美国儿童有私人保险，19%有公共保险；其余15%没有保险。在至少看过一次医生的71.5%的儿童中，平均就诊次数为3.9次，但范围从无保险儿童的2.7次到有私人保险儿童的4.2次不等。略多于一半的儿童有处方，平均为5.4张处方。大多数儿童（85%）产生了医疗支出，有任何支出的儿童平均支出为1019美元。私人医疗保险是儿童医疗费用的最大支付方，甚至比普通人群中的情况更甚。然而，近21%的儿童医疗保健支出由儿童家庭自掏腰包支付。数据还显示，各州的平均住院时长存在显著差异，从2.7天到4.0天不等，且通过急诊科入院的比例也因州而异，从9%到23%不等。受伤是住院的主要原因，在10至14岁儿童中，每6次住院中有1次是因伤住院。在10至17岁年龄组中，每7次住院中有1次是由于精神障碍。在15至17岁青少年中，超过三分之一的住院与分娩和怀孕有关。
儿童对医疗服务的使用因其所拥有的医疗保险类型而有很大差异。儿童的医疗支出中有相当大一部分是自掏腰包，对于有重大健康问题的儿童来说可能相当可观，这可能给低收入家庭带来沉重负担。各州的住院情况存在显著差异。
