Fisher Monica A, Mascarenhas Ana K
Case Western Reserve University, Department of Orthodontics, Cleveland, OH 44106-4905, USA.
Community Dent Oral Epidemiol. 2007 Aug;35(4):263-71. doi: 10.1111/j.1600-0528.2007.00341.x.
Data are lacking to support the contention that Medicaid services improve utilization of healthcare services and result in better health.
To compare sociodemographic, utilization of healthcare services and health status characteristics among Medicaid-eligible children.
The third National Health and Nutrition Examination Survey included 2821 children 2-16 years of age eligible for Medicaid. The main outcome measures are annual physician visit, annual dentist visit, general health status, oral health status, asthma (second most common childhood disease), dental caries (most common childhood disease), asthma treatment needs, and dental treatment needs. We quantified the association of these outcome measures with Medicaid insurance status and sociodemographic status using multiple logistic regression modeling, taking into account the complex survey design and sample weights.
Among Medicaid-eligible children, 27% were uninsured. Among uninsured Medicaid-eligible children, 62% had an annual physician visit, 32% had an annual dentist visit, 10% needed asthma treatment, and 57% needed dental treatment. Among insured Medicaid-eligible children, 81% had an annual physician visit, 39% had an annual dentist visit, 13% needed asthma treatment, and 42% needed dental treatment. After simultaneously taking into account other characteristics, uninsured Medicaid-eligible children were more likely to not have an annual physician visit (OR(NoMDvisit) = 2.21; 1.26-3.90), and to need dental treatment (OR(DentalNeed) = 1.57; 1.13-2.18).
This USA population-based study found disparities exist within Medicaid's services between utilization of dental and medical services. Medicaid insurance improved utilization of medical services, but did not improve the utilization of dental services. This suggests that Medicaid insurance does not improve access to dental services for poor children.
缺乏数据支持医疗补助服务能提高医疗服务利用率并带来更好健康状况这一观点。
比较符合医疗补助条件的儿童的社会人口统计学特征、医疗服务利用率和健康状况特征。
第三次全国健康与营养检查调查纳入了2821名2至16岁符合医疗补助条件的儿童。主要结局指标包括年度看医生次数、年度看牙医次数、总体健康状况、口腔健康状况、哮喘（第二常见的儿童疾病）、龋齿（最常见的儿童疾病）、哮喘治疗需求和牙科治疗需求。我们使用多重逻辑回归模型，在考虑复杂的调查设计和样本权重的情况下，量化了这些结局指标与医疗补助保险状况和社会人口统计学状况之间的关联。
在符合医疗补助条件的儿童中，27%没有保险。在没有保险的符合医疗补助条件的儿童中，62%每年看一次医生，32%每年看一次牙医，10%需要哮喘治疗，57%需要牙科治疗。在有保险的符合医疗补助条件的儿童中，81%每年看一次医生，39%每年看一次牙医，13%需要哮喘治疗，42%需要牙科治疗。在同时考虑其他特征后，没有保险的符合医疗补助条件的儿童更有可能每年不看医生（未看医生的比值比=2.21；1.26 - 3.90），并且更需要牙科治疗（牙科治疗需求的比值比=1.57；1.13 - 2.18）。
这项基于美国人群的研究发现，医疗补助服务在牙科和医疗服务的利用率方面存在差异。医疗补助保险提高了医疗服务的利用率，但没有提高牙科服务的利用率。这表明医疗补助保险并没有改善贫困儿童获得牙科服务的机会。
