Perry Cynthia D, Kenney Genevieve M
Urban Institute, Health Policy Center, 2100 M St, NW, Washington, DC 20037, USA.
Pediatrics. 2007 Dec;120(6):e1393-401. doi: 10.1542/peds.2006-3520.
Child health problems that are caused or exacerbated by health behaviors remain a leading cause of medical spending for children. We examined receipt of clinician advice by low-income children, comparing children who had public insurance with those who had private insurance, as well as with children who were uninsured for part or all of the year.
We used children who were aged 3 to 17 and living in families with incomes of <250% of the federal poverty level in the Medical Expenditure Panel Survey data from 2001 to 2003 to estimate linear probability models on receipt of preventive advice. The main outcome measures were receipt of clinician's advice about healthy eating, physical activity, the harmful effects of smoking in the home, proper safety restraints in a car, and use of a bicycle helmet. We also examined 2 related barriers to receiving clinician advice: whether the child had any preventive care visits in the past year and whether the child had a usual source of care other than a hospital emergency department.
Publicly insured children were more likely than privately insured, full-year-uninsured children, and part-year-uninsured children to have had a preventive care visit in the past year, but regardless of health insurance group, many children went without preventive care. Even conditional on having had a preventive care visit, 48% did not receive clinician advice in any of the areas measured, and 41% of the overweight children were advised about neither healthy eating nor exercise in the past year.
Enrolling more uninsured children in Medicaid and State Children's Health Insurance Programs could improve the chances that families receive advice about health behaviors and injury prevention; however, nearly half of the children who were insured for the entire year did not receive important advice from their clinicians.
由健康行为导致或加剧的儿童健康问题仍然是儿童医疗支出的主要原因。我们研究了低收入儿童接受临床医生建议的情况，比较了参加公共保险的儿童、参加私人保险的儿童以及部分或全年未参保的儿童。
我们利用2001年至2003年医疗支出小组调查数据中年龄在3至17岁、家庭收入低于联邦贫困线250%的儿童，来估计接受预防性建议的线性概率模型。主要结局指标包括是否收到临床医生关于健康饮食、体育活动、家中吸烟的有害影响、汽车上正确使用安全约束装置以及使用自行车头盔的建议。我们还研究了接受临床医生建议的两个相关障碍：孩子在过去一年是否进行过任何预防性保健就诊，以及孩子是否有除医院急诊科之外的常规医疗服务来源。
与参加私人保险、全年未参保和部分时间未参保的儿童相比，参加公共保险的儿童在过去一年进行预防性保健就诊的可能性更大，但无论医疗保险类别如何划分，许多儿童都未接受预防性保健。即使在进行了预防性保健就诊的情况下，仍有48%的儿童在任何一项测量领域中都未收到临床医生的建议，并且在过去一年中，41%的超重儿童既未得到关于健康饮食的建议，也未得到关于锻炼的建议。
让更多未参保儿童加入医疗补助计划和儿童健康保险计划，可以增加家庭获得健康行为和伤害预防建议的机会；然而，全年参保的儿童中近一半未从临床医生那里获得重要建议。
