Pagán José A, Puig Andrea, Soldo Beth J
Department of Economics and Finance, Institute for Population Health Policy, University of Texas-Pan American, Edinburg, TX 78541, USA.
Health Econ. 2007 Dec;16(12):1359-69. doi: 10.1002/hec.1226.
The lack of health insurance coverage could be a potentially important deterrent to the use of preventive health care by older adults with high rates of chronic co-morbidities. We use survey data from 12 100 Mexican adults ages 50 and older who participated in the 2001 Mexican Health and Aging Study (MHAS) to analyze the relation between health insurance coverage and the use of preventive health-care services in Mexico. Uninsured adults were less likely to use preventive screenings for hypertension, high cholesterol, diabetes and (breast, cervical and prostate) cancer than insured adults. After adjusting for other factors affecting preventive care utilization in a logistic regression model, we found that these results still hold for high cholesterol and diabetes screening. Similar results hold for the population not working during the survey week and for adults earning below 200% of the poverty line. Our results suggest that insured adults are in a relatively better position to detect some chronic diseases - and have them treated promptly - than uninsured adults because they have better access to cost-effective preventive screenings. Recent public policy initiatives to increase health insurance coverage rates in Mexico could lead to substantially higher preventive health-care utilization rates and improvements in population health.
缺乏医疗保险 coverage 可能是患有高慢性合并症比率的老年人使用预防性医疗保健的一个潜在重要阻碍。我们使用来自 12100 名年龄在 50 岁及以上参与 2001 年墨西哥健康与老龄化研究（MHAS）的墨西哥成年人的调查数据，来分析墨西哥医疗保险 coverage 与预防性医疗保健服务使用之间的关系。未参保成年人比参保成年人更不可能对高血压、高胆固醇、糖尿病以及（乳腺癌、宫颈癌和前列腺癌）进行预防性筛查。在逻辑回归模型中对影响预防性保健利用的其他因素进行调整后，我们发现这些结果对于高胆固醇和糖尿病筛查仍然成立。对于在调查周未工作的人群以及收入低于贫困线 200%的成年人，也有类似结果。我们的结果表明，参保成年人比未参保成年人在检测某些慢性病并及时治疗方面处于相对更好的位置，因为他们能更好地获得具有成本效益的预防性筛查。墨西哥最近提高医疗保险覆盖率的公共政策举措可能会导致预防性医疗保健利用率大幅提高以及人口健康状况改善。
