Cunningham Peter J, Hadley Jack, Kenney Genevieve, Davidoff Amy J
Center for Studying Health System Change, 600 Maryland Ave., S.W., Suite 550, Washington, DC 20024, USA.
Health Serv Res. 2007 Feb;42(1 Pt 1):265-85. doi: 10.1111/j.1475-6773.2006.00603.x.
To examine the effects of policy, health system, and sociodemographic characteristics on the likelihood that uninsured persons pay a lower price at their regular source of care, or that they are aware of lower priced providers in their community.
The 2003 Community Tracking Study household survey, a nationally representative sample of the U.S. population and 60 randomly selected communities.
The survey asked uninsured persons if they paid full or reduced cost at their usual source of medical care, or if they were aware of providers in their community that charge less for uninsured people. We use binomial and multinomial logistic regression analysis to examine the effects of various policy, health system, and sociodemographic characteristics on use and awareness of lower priced providers. We focus especially on the effects of safety-net capacity, measured by safety-net hospitals, community health centers, physicians' charity care, and Community Access Program (CAP) grants.
Less than half of the uninsured (47.5 percent) reported that they used or were aware of a lower priced provider in their community. Multivariate regression analysis shows that greater safety-net capacity is associated with a higher likelihood of having a lower priced provider as the regular source of care and greater awareness of lower priced providers. Lower incomes and racial/ethnic minorities also had a higher likelihood of having a lower priced provider, although health status did not have statistically significant effects.
Although increased safety-net capacity may lead to more uninsured having a lower priced provider, many uninsured who live near safety-net providers are not aware of their presence. Greater outreach designed to increase awareness may be needed in order to increase the effectiveness of safety-net providers in improving access to care for the uninsured.
研究政策、卫生系统及社会人口学特征对未参保者在其常规就医机构支付较低价格，或知晓所在社区有低价医疗服务提供者的可能性的影响。
2003年社区追踪研究家庭调查，该调查是对美国人口的全国代表性样本以及60个随机选取的社区进行的调查。
该调查询问未参保者在其常规医疗服务机构支付的是全价还是降价费用，或者他们是否知晓所在社区有为未参保者收费较低的医疗服务提供者。我们使用二项式和多项逻辑回归分析来研究各种政策、卫生系统及社会人口学特征对低价医疗服务提供者的使用和知晓情况的影响。我们特别关注由安全网医院、社区卫生中心、医生慈善医疗及社区准入计划（CAP）补助所衡量的安全网能力的影响。
不到一半的未参保者（47.5%）报告称他们使用过或知晓所在社区有低价医疗服务提供者。多变量回归分析表明，更强的安全网能力与以低价医疗服务提供者作为常规就医机构的可能性更高以及对低价医疗服务提供者的知晓度更高相关。较低收入者以及少数种族/族裔群体也更有可能有低价医疗服务提供者，不过健康状况并无统计学上的显著影响。
尽管增强安全网能力可能会使更多未参保者有低价医疗服务提供者，但许多住在安全网提供者附近的未参保者并不知道其存在。可能需要开展更多旨在提高知晓度的宣传活动，以增强安全网提供者在改善未参保者获得医疗服务方面的成效。
