Department of Family Medicine, Center for Community Health Studies, University of Southern California Keck School of Medicine, 1000 South Fremont Avenue, Alhambra, CA 91803, USA.
J Immigr Minor Health. 2010 Jun;12(3):273-81. doi: 10.1007/s10903-008-9185-8. Epub 2008 Sep 9.
To examine differences and trends in health insurance coverage and access to care for California families by immigration status.
Cross-sectional data on 37,236 families with young children <18 years of age from the 2001, 2003 and 2005 California Health Interview Survey are used to assess trends in health insurance and access to care for children and their parents by four immigration dyads: (1) both are Citizens; (2) child is a legal resident/citizen, and parent is legal resident (Documented); (3) child is a citizen, and parent is undocumented (Mixed); and (4) both are Undocumented.
Before and after adjustment for covariates, only children in Undocumented dyads were less likely than Citizen dyads to have insurance (OR = 0.20, CI: 0.16-0.26) and all three measures of access: physician visits (OR = 0.69, CI: 0.52-0.91), dental visits (OR = 0.47, CI: 0.35-0.63), and a regular source of care (OR = 0.51, CI: 0.37-0.69). Parents in all non-Citizen dyads had poorer access than Citizen dyads across all measures, with the exception of dental visits and a regular source for parents in Documented dyads. Children of all dyads except Citizens were more likely to be insured in 2005 vs. 2001. The largest gain was for undocumented dyad children with 2.77 times higher odds (CI: 1.62-4.75) of being insured in 2005 vs. 2001. All children dyads except Mixed were also more likely to have a physician visit. For parents, there was only a decrease in insurance coverage for Citizen dyads (OR = 0.79, CI: 0.67-0.93) and few changes in access. Conclusions While there were relatively few disparities and some improvements in insurance coverage and access for children in California (except for undocumented children), concomitant changes for parents were not observed. Without attention to the family in health care reforms, disparities may not fully resolve for children and may continue or even increase for parents.
研究加利福尼亚州家庭的医疗保险覆盖范围和获得医疗服务的情况，按移民身份进行差异和趋势分析。
使用 2001 年、2003 年和 2005 年加利福尼亚州健康访谈调查中 37236 个有 18 岁以下幼儿的家庭的横断面数据，评估四类移民对子代及其父母的健康保险和获得医疗服务的情况：（1）父母均为公民；（2）孩子为合法居民/公民，父母为合法居民（有证件）；（3）孩子为公民，父母为无证件（混合）；（4）父母均为无证件。
在调整协变量后，只有无证家庭的子女比公民家庭的子女更不可能有保险（OR=0.20，95%CI：0.16-0.26），而且所有三种获得医疗服务的指标都较差：看医生（OR=0.69，95%CI：0.52-0.91）、看牙医（OR=0.47，95%CI：0.35-0.63）和有常规医疗服务来源（OR=0.51，95%CI：0.37-0.69）。除了有证件家庭的父母看牙医和有常规医疗服务来源的情况外，所有非公民家庭的父母的获得医疗服务的情况都比公民家庭差。除了公民家庭的子女外，所有家庭的子女在 2005 年比 2001 年更有可能有保险。无证家庭的子女的保险覆盖率增加最多，有 2.77 倍的可能性（95%CI：1.62-4.75）。除了混合家庭的子女外，所有子女家庭的子女都更有可能看医生。对于父母来说，只有公民家庭的父母的保险覆盖率下降（OR=0.79，95%CI：0.67-0.93），而获得医疗服务的情况几乎没有变化。
尽管加利福尼亚州儿童的医疗保险覆盖范围和获得医疗服务的情况相对较少，存在一些差异，但对父母的影响并没有观察到。如果不关注医疗保健改革中的家庭问题，儿童的差异可能无法完全解决，父母的差异可能会继续存在，甚至可能会增加。
