Sabatino Susan A, Coates Ralph J, Uhler Robert J, Alley Linda G, Pollack Lori A
Division of Cancer Prevention and Control, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Cancer. 2006 Jun 1;106(11):2466-75. doi: 10.1002/cncr.21879.
The health insurance and cost barriers to care among cancer survivors age <65 years were examined.
Using the 1998 and 2000 National Health Interview Survey, survivors ages 18 to 64 years (n=1718) were compared with similarly aged adults without cancer (n=50,276) to examine health insurance and reported delayed/missed needed medical care within the previous year because of cost. Findings were initially adjusted for age, sex, race, and ethnicity, and further adjusted for employment, income, health status, marital status, and region.
Before adjustment, survivors were less likely to be uninsured (12.4% vs. 18.0%) and more likely to have public insurance (11.2% vs. 6.2%). After initial adjustment, survivors were as likely to lack insurance, less likely to have private insurance, and more likely to have public insurance. After further adjusting, differences in being uninsured were found to be small, differences in having private insurance were eliminated, and differences in having public insurance were reduced. Survivors most likely to lack insurance were younger, female, African-American, or lower income. Survivors, particularly uninsured or publicly insured survivors, were more likely to delay/miss care because of cost. Overall, 20.9% of survivors, including 68% of uninsured survivors, reported delaying/missing needed care.
Health insurance coverage among cancer survivors age<65 years appears to be comparable to that of adults of similar age, sex, race, and ethnicity, but survivors may more likely be publicly insured. Differences are attributable in part to employment, income, and health status, factors potentially influenced by cancer. Unmet medical care needs because of cost were common among survivors, particularly uninsured survivors.
对年龄小于65岁的癌症幸存者的医疗保险及医疗费用障碍进行了研究。
利用1998年和2000年的全国健康访谈调查，将18至64岁的幸存者（n = 1718）与年龄相仿的无癌症成年人（n = 50276）进行比较，以研究医疗保险情况，并了解在前一年中因费用问题而报告的延迟/错过所需医疗护理的情况。研究结果最初根据年龄、性别、种族和民族进行了调整，随后又根据就业、收入、健康状况、婚姻状况和地区进行了进一步调整。
调整前，幸存者未参保的可能性较小（12.4%对18.0%），拥有公共保险的可能性较大（11.2%对6.2%）。初次调整后，幸存者未参保的可能性相当，拥有私人保险的可能性较小，拥有公共保险的可能性较大。进一步调整后，未参保方面的差异较小，拥有私人保险方面的差异消除，拥有公共保险方面的差异减小。最有可能未参保的幸存者是年龄较小、女性、非裔美国人或低收入者。幸存者，尤其是未参保或参加公共保险的幸存者，因费用问题更有可能延迟/错过医疗护理。总体而言，20.9%的幸存者，包括68%的未参保幸存者，报告延迟/错过所需护理。
年龄小于65岁的癌症幸存者的医疗保险覆盖情况似乎与年龄、性别、种族和民族相仿的成年人相当，但幸存者可能更有可能参加公共保险。差异部分归因于就业、收入和健康状况，这些因素可能受到癌症的影响。因费用问题未满足的医疗护理需求在幸存者中很常见，尤其是未参保的幸存者。
