Hill Ian, Stockdale Holly, Evert Marilynn, Gifford Kathleen
The Urban Institute, Washington, DC, USA,
Matern Child Health J. 2006 Nov;10(6):517-25. doi: 10.1007/s10995-006-0145-4.
The Covering Kids and Families (CKF) program seeks to expand health insurance coverage for children by supporting community-based outreach and enrollment. For the evaluation of CKF, researchers conducted focus groups to explore parents' experiences accessing health care for their children, and to assess whether these experiences affected decisions to enroll their children in Medicaid or the State Children's Health Insurance Program (SCHIP).
In May and June 2003, 13 focus groups were conducted in 5 cities--Everett, MA; Denver, CO; Los Angeles, CA; Mena, AR; and San Antonio, TX. In each community, groups were conducted with parents of children insured under Medicaid or SCHIP and parents of uninsured children. Three groups were conducted with Spanish-speaking parents in two communities--Denver and Los Angeles.
Access to primary care was considered good by most parents with children in Medicaid and SCHIP. Among parents of uninsured children, there was more variation in perceptions of access to care. For parents of both uninsured and insured children, access to dentists and specialists was more problematic. Spanish-speaking families reported numerous barriers to care due to language differences and perceived discrimination. All focus group participants said that they placed great value on health insurance.
Even when parents encountered problems accessing care, very few indicated that this discouraged them from enrolling their children into Medicaid or SCHIP, or from renewing their children's public coverage.
“关爱儿童与家庭”（CKF）项目旨在通过支持基于社区的宣传和登记工作来扩大儿童的医疗保险覆盖范围。为了评估CKF项目，研究人员开展了焦点小组讨论，以探究家长为子女获取医疗保健服务的经历，并评估这些经历是否会影响他们为子女登记参加医疗补助计划或州儿童健康保险计划（SCHIP）的决定。
2003年5月和6月，在马萨诸塞州埃弗雷特、科罗拉多州丹佛、加利福尼亚州洛杉矶、阿肯色州梅纳和得克萨斯州圣安东尼奥这5个城市开展了13次焦点小组讨论。在每个社区，分别与参加医疗补助计划或SCHIP的儿童的家长以及未参保儿童的家长进行了小组讨论。在丹佛和洛杉矶这两个社区，与讲西班牙语的家长进行了3次小组讨论。
大多数有子女参加医疗补助计划和SCHIP的家长认为获得初级保健服务的情况良好。在未参保儿童的家长中，对获得医疗服务的看法存在较大差异。对于未参保和已参保儿童的家长来说，看牙医和专科医生的机会问题更大。讲西班牙语的家庭报告称，由于语言差异和感知到的歧视，他们在获得医疗服务方面面临诸多障碍。所有焦点小组参与者均表示他们非常重视医疗保险。
即使家长在获取医疗服务时遇到问题，也很少有人表示这会阻碍他们为子女登记参加医疗补助计划或SCHIP，或者续保子女的公共医疗保险。
