Hadley Jack
The Urban Institute, Washington, DC 20037, USA.
JAMA. 2007 Mar 14;297(10):1073-84. doi: 10.1001/jama.297.10.1073.
Given the large and increasing number of uninsured US individuals, identifying the health consequences of being uninsured has assumed increased importance.
To compare medical care use and short-term health changes among US uninsured individuals and insured nonelderly individuals following a health shock caused by either an unintentional injury or the onset of a chronic condition.
DESIGN, SETTING, AND PARTICIPANTS: Multivariate logistic regression analysis of longitudinal data from Medical Expenditure Panel Surveys (1997-2004) limited to nonelderly individuals whose insurance status was established for 2 months prior to 1 or more unintentional injuries (20 783 cases among 15 866 individuals) and onset of 1 or more chronic conditions (10 485 cases among 7954 individuals).
Self-reported medical care use and change in short-term general health status following the health shock.
After experiencing a health shock, uninsured individuals were less likely to obtain any medical care (unintentional injury [UI] group: 78.8% uninsured vs 88.7% insured [adjusted odds ratio {AOR}, 0.47; 95% confidence interval {CI}, 0.43-0.51]; new chronic condition [NCC] group: 81.7% uninsured vs 91.5% insured [AOR, 0.45; 95% CI, 0.40-0.50]) and more likely not to have received any recommended follow-up care (UI group: 19.3% uninsured vs 9.2% insured [AOR, 2.59; 95% CI, 2.15-3.11]; NCC group: 9.4% uninsured vs 4.4% insured [AOR, 1.65; 95% CI, 1.32-2.06]). Based on the AORs, uninsured individuals with UIs had fewer outpatient visits (6.1% uninsured vs 9.0% insured; AOR, 0.71 [95% CI, 0.63-0.80]), office-based visits (41.8% uninsured vs 57.3% insured; AOR, 0.59 [95% CI, 0.56-0.62]), and prescription medicines (35.5% uninsured vs 35.6% insured; AOR, 0.71 [95% CI, 0.67-0.75]). Uninsured individuals with an NCC had fewer office-based visits (58.9% uninsured vs 68.3% insured; AOR, 0.77 [95% CI, 0.72-0.82]) and prescription medicines (52.7% uninsured vs 61.7% insured; AOR, 0.66 [95% CI, 0.57-0.76]). Higher proportions of uninsured individuals reported a decrease in health status (classified as much worse) approximately 3.5 months after the health shock (UI group: 9.8% uninsured vs 6.7% insured; AOR, 0.86 [95% CI, 0.75-0.98]; NCC group: 12.3% uninsured vs 10.1% insured; AOR, 0.74 [95% CI, 0.68-0.80]). Uninsured individuals with UIs were more likely to report not being fully recovered and no longer receiving treatment. At approximately 7 months after the health shock, uninsured individuals with NCCs still reported worse health status.
Among individuals who experienced a health shock caused by an unintentional injury or a new chronic condition, uninsured individuals reported receiving less medical care and poorer short-term changes in health than those with insurance.
鉴于美国未参保人群数量众多且不断增加，确定未参保的健康后果变得愈发重要。
比较美国未参保人群和参保非老年人群在因意外伤害或慢性病发作导致健康冲击后的医疗服务利用情况和短期健康变化。
设计、设置和参与者：对医疗支出面板调查（1997 - 2004年）的纵向数据进行多变量逻辑回归分析，数据仅限于在1次或多次意外伤害（15866人中有20783例）和1次或多次慢性病发作（7954人中有10485例）前2个月确定保险状况的非老年人群。
健康冲击后自我报告的医疗服务利用情况和短期总体健康状况变化。
经历健康冲击后，未参保人群获得任何医疗服务的可能性较小（意外伤害[UI]组：78.8%未参保 vs 88.7%参保[调整优势比{AOR}，0.47；95%置信区间{CI}，0.43 - （此处原文有误，应为0.51）]；新慢性病[NCC]组：81.7%未参保 vs 91.5%参保[AOR，0.45；95% CI，0.40 - 0.50]），且更有可能未接受任何推荐的后续护理（UI组：19.3%未参保 vs 9.2%参保[AOR，2.59；95% CI，2.15 - 3.11]；NCC组：9.4%未参保 vs 4.4%参保[AOR，1.65；95% CI，1.32 - 2.06]）。根据优势比，发生意外伤害的未参保人群门诊就诊次数较少（6.1%未参保 vs 9.0%参保；AOR，0.71[95% CI，0.63 - 0.80]），基于办公室的就诊次数较少（41.8%未参保 vs 57.3%参保；AOR，0.59[95% CI，0.56 - 0.62]），以及处方药使用较少（35.
