Szilagyi Peter G, Dick Andrew W, Klein Jonathan D, Shone Laura P, Zwanziger Jack, Bajorska Alina, Yoos H Lorrie
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Pediatrics. 2006 Feb;117(2):486-96. doi: 10.1542/peds.2005-0340.
Uninsured children with asthma are known to face barriers to asthma care, but little is known about the impact of health insurance on asthma care.
We sought to assess the impact of New York's State Children's Health Insurance Program (SCHIP) on health care for children with asthma.
Parents of a stratified random sample of new enrollees in New York's SCHIP were interviewed by telephone shortly after enrollment (baseline, n = 2644 [74% of eligible children]) and 1 year later (follow-up, n = 2310 [87%]). Asthma was defined by parent report using questions based on National Heart, Lung, and Blood Institute criteria. A comparison group (n = 401) who enrolled in SCHIP 1 year later was interviewed as a test for secular trends.
Access (having a usual source of care [USC], unmet health needs, problems receiving acute asthma care), asthma-related medical visits, quality (continuity of care at the USC, problems receiving chronic asthma care, use of antiinflammatory medications), and asthma outcomes (change in asthma care or severity) were the main outcome measures used. Bivariate and multivariate analyses compared measures at baseline (year before SCHIP) versus follow-up (year during SCHIP).
Three-hundred eighty-three children (14%) had asthma at baseline, and 364 had asthma at follow-up (16%). No secular trends were detected between the baseline study group and the comparison group. After enrollment in SCHIP, improvements were noted in access: lacking a USC (decrease from 5% to 1%), unmet health needs (48% to 21%), and problems getting to the USC for asthma (13 to 4%). Children had fewer asthma-related attacks and medical visits after SCHIP (mean number of attacks: 9.5 to 3.8: mean number of asthma visits: 3.0 to 1.5; hospitalizations: 11% to 3%). Quality of asthma care improved for general measures (most/all visits to USC: 53% to 94%; mean rating of provider: 7.9 to 8.8 of 10) and asthma-specific measures (problems getting to the USC for asthma care when child was well: 13% to 1%). More than two thirds of the parents at follow-up reported that both quality of asthma care and asthma severity were "better or much better" than at baseline, generally because of insurance coverage or lower costs of medications and medical care.
Enrollment in New York's SCHIP was associated with improvements in access to asthma care, quality of asthma care, and asthma-specific outcomes. These findings suggest that health insurance improves the health of children with asthma.
已知未参保的哮喘儿童在获得哮喘护理方面面临障碍，但关于健康保险对哮喘护理的影响知之甚少。
我们试图评估纽约州儿童健康保险计划（SCHIP）对哮喘儿童医疗保健的影响。
在纽约州儿童健康保险计划新参保者的分层随机样本中，家长在参保后不久（基线，n = 2644 [符合条件儿童的74%]）和1年后（随访，n = 2310 [87%]）接受电话访谈。哮喘由家长报告根据基于美国国立心肺血液研究所标准的问题来定义。1年后参保纽约州儿童健康保险计划的一个对照组（n = 401）接受访谈以检验长期趋势。
获得医疗服务（有常规医疗服务来源[USC]、未满足的健康需求、接受急性哮喘护理存在的问题）、与哮喘相关的就诊、质量（在常规医疗服务来源处的连续性护理、接受慢性哮喘护理存在的问题、使用抗炎药物）以及哮喘结局（哮喘护理或严重程度的变化）是所使用的主要结局指标。双变量和多变量分析比较了基线（参保纽约州儿童健康保险计划前一年）与随访（参保纽约州儿童健康保险计划期间）的各项指标。
383名儿童（14%）在基线时有哮喘，364名在随访时有哮喘（16%）。在基线研究组和对照组之间未检测到长期趋势。参保纽约州儿童健康保险计划后，在获得医疗服务方面有改善：缺乏常规医疗服务来源（从5%降至1%）、未满足的健康需求（48%降至至21%）以及前往常规医疗服务来源处接受哮喘护理存在的问题（13%降至4%）。参保纽约州儿童健康保险计划后，儿童哮喘相关发作和就诊次数减少（平均发作次数：9.5次降至3.8次；平均哮喘就诊次数：3.0次降至1.5次；住院率：11%降至3%）。哮喘护理质量在一般指标（大多数/所有就诊于常规医疗服务来源处：53%升至94%；提供者平均评分：从10分制中的7.9分升至8.8分）和哮喘特定指标方面有所改善（儿童病情稳定时前往常规医疗服务来源处接受哮喘护理存在的问题：13%降至至1%）。超过三分之二的随访家长报告哮喘护理质量和哮喘严重程度比基线时“更好或好得多”，通常是因为保险覆盖或药物及医疗护理成本降低。
参保纽约州儿童健康保险计划与哮喘护理的可及性、哮喘护理质量以及哮喘特定结局的改善相关。这些发现表明健康保险可改善哮喘儿童的健康状况。
