Olson Lynn M, Tang Suk-fong S, Newacheck Paul W
Department of Practice, American Academy of Pediatrics, Elk Grove Village, Ill 60007, USA.
N Engl J Med. 2005 Jul 28;353(4):382-91. doi: 10.1056/NEJMsa043878.
Estimates of the number of uninsured people in the United States usually exclude those with discontinuous coverage. The effects of gaps in insurance coverage for children on access to and use of ambulatory care are poorly understood.
We analyzed a sample of 26,955 children under 18 years of age from the 2000 and 2001 National Health Interview Surveys. Children with discontinuous health insurance coverage were compared with those who were uninsured all year and with those who had public or private full-year coverage.
During the last 12 months before they were interviewed, 6.6 percent of children in the United States had no insurance and an additional 7.7 percent had gaps in insurance. Children who had full-year insurance coverage (private or public) had low rates of unmet health care needs and good access to care (delayed care, unmet medical care, and unfilled prescriptions were reported in <3 percent, and <5 percent had no usual place of care). Access to care was much worse for children who were uninsured for part of the year and for those who were uninsured for the full year (delayed care, 20.2 percent and 15.9 percent, respectively; unmet medical care, 13.4 percent and 12.6 percent, respectively; unfilled prescriptions, 9.9 percent and 10.0 percent, respectively; P<0.01 for all comparisons with children with full-year, private insurance coverage). In multivariate analyses adjusting for age, income, race or ethnic group, region, citizenship, family structure, parental employment, and health status, the differences in access to care persisted. As compared with the parents of children with full-year, private insurance, parents of children uninsured for the full year were far more likely to report delaying care (adjusted odds ratio, 12.65; 95 percent confidence interval, 9.45 to 16.94), as were parents of children uninsured for part of the year (adjusted odds ratio, 13.65; 95 percent confidence interval, 10.41 to 17.90).
Children with gaps in health insurance coverage commonly do not seek medical care, including preventive visits, and do not get prescriptions filled. These findings are important for both research and policy and point to the need for more encompassing and sensitive measures of the situation of being uninsured.
美国未参保人数的估计通常不包括那些保险 coverage 不连续的人。人们对儿童保险 coverage 缺口对门诊医疗服务的获取和使用的影响了解甚少。
我们分析了2000年和2001年全国健康访谈调查中26955名18岁以下儿童的样本。将健康保险 coverage 不连续的儿童与全年未参保的儿童以及拥有公共或私人全年 coverage 的儿童进行比较。
在接受访谈前的最后12个月里，美国6.6%的儿童没有保险，另有7.7%的儿童存在保险 coverage 缺口。拥有全年保险 coverage（私人或公共）的儿童未满足医疗需求的发生率较低，且获得医疗服务的机会良好（报告延迟就医、未满足医疗需求和未配药的比例均低于3%，且<5%的儿童没有固定的就医地点）。部分年份未参保的儿童和全年未参保的儿童获得医疗服务的情况要差得多（延迟就医的比例分别为20.2%和15.9%；未满足医疗需求的比例分别为13.4%和12.6%；未配药的比例分别为9.9%和10.0%；与拥有全年私人保险的儿童相比，所有比较的P<0.01）。在对年龄、收入、种族或族裔群体、地区、公民身份、家庭结构、父母就业和健康状况进行调整的多变量分析中，获得医疗服务的差异仍然存在。与拥有全年私人保险的儿童的父母相比，全年未参保儿童的父母更有可能报告延迟就医（调整后的优势比为12.65；95%置信区间为9.45至16.94），部分年份未参保儿童的父母也是如此（调整后的优势比为13.65；95%置信区间为10.41至17.90）。
健康保险 coverage 存在缺口的儿童通常不寻求医疗服务，包括预防性就诊，也不进行配药。这些发现对研究和政策都很重要，并指出需要采取更全面、更敏感的措施来衡量未参保状况。
