Litaker David, Cebul Randall D
Department of Medicine, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio 44106-6033, USA.
Med Care. 2003 Sep;41(9):1086-95. doi: 10.1097/01.MLR.0000083741.80192.E0.
Access to health care, reflected by an ability to meet one's health needs, is influenced by individual characteristics and the environment. Although managed care activity influences healthcare prices and overall utilization, its relationship to access and its broader effects across different insurance categories has not been well studied.
To examine the association between managed care activity and individuals' access to care, and to assess differences in this relationship by insurance status.
Cross-sectional survey of households conducted in 1998.
A sample of 15,613 adult Ohio residents.
Self-reported difficulties in obtaining health care, medications, supplies, or medical equipment in the past year.
A total of 1248 (8.0%) identified an access problem. In bivariate analyses, these problems were more common among continuously and intermittently uninsured individuals compared with those who were continuously insured during the previous 12 months (P<0.001) and also among those living in areas with more managed care (P=0.01). After accounting for other individual and environmental characteristics in hierarchical analyses, individuals residing in areas with more managed care had 28% higher odds of reporting problems obtaining care than those elsewhere (multivariate odds ratio, 1.28; 95% confidence interval, 1.04-1.58]; P=0.02). No significant interaction between managed care penetration and insurance status was observed.
Greater managed care activity is associated with unfavorable patterns of healthcare access despite an individual's insurance status, suggesting more pervasive effects. Unintended effects should be carefully evaluated when formulating future programs that seek to address disparities in access to care.
获得医疗保健的机会，体现在满足个人健康需求的能力上，受到个体特征和环境的影响。尽管管理式医疗活动会影响医疗价格和总体利用率，但其与获得医疗保健机会的关系以及在不同保险类别中的更广泛影响尚未得到充分研究。
研究管理式医疗活动与个人获得医疗保健机会之间的关联，并评估这种关系在保险状况方面的差异。
1998年对家庭进行的横断面调查。
15613名俄亥俄州成年居民的样本。
自我报告过去一年在获得医疗保健、药品、用品或医疗设备方面的困难。
共有1248人（8.0%）发现存在获得医疗保健方面的问题。在双变量分析中，与过去12个月持续参保的人相比，持续未参保和间断未参保的人出现这些问题的情况更为常见（P<0.001），在管理式医疗更多的地区居住的人也是如此（P=0.01）。在分层分析中考虑了其他个体和环境特征后，居住在管理式医疗更多地区的人报告获得医疗保健有问题的几率比其他地区的人高28%（多变量优势比为1.28；95%置信区间为1.04-1.58；P=0.02）。未观察到管理式医疗渗透率与保险状况之间存在显著交互作用。
尽管个人的保险状况不同，但管理式医疗活动增加与不利的医疗保健获得模式相关，这表明其影响更为普遍。在制定未来旨在解决医疗保健获得差距的计划时，应仔细评估意外影响。
