Cummings Janet R, Lavarreda Shana Alex, Rice Thomas, Brown E Richard
BA, Department of Health Services, School of Public Health, Campus Box 951772, Los Angeles, CA 90095-1772, USA.
Pediatrics. 2009 Mar;123(3):e411-8. doi: 10.1542/peds.2008-1874.
Many studies have documented the adverse consequences of uninsurance for children, but less is known about the differential effects of varying periods of uninsurance. This study examines the relative effects of varying periods of uninsurance (uninsured for 1-4 months, 5-11 months, or all year) on children's access to care.
Using data from the 2005 California Health Interview Survey Children's File (ages 0-11), we estimated logistic regressions to examine the effect of insurance status on 6 measures of health care access, controlling for child demographics, child health status, family characteristics, and urban residence. Indicators for insurance status included the following categories: (1) privately insured all year (reference); (2) Medicaid all year; (3) State Children's Health Insurance Program all year; (4) uninsured for 1 to 4 months; (5) uninsured for 5 to 11 months; (6) uninsured all year; and (7) other insurance all year.
We found that children who experience short spells of uninsurance (1-4 months) are less likely to have a usual source of care and are more likely to experience delays in needed care than those with continuous private or public insurance. The consequences are even worse for children who experience more substantial periods of uninsurance, because they are also less likely to receive preventive care (well-child visits and flu shots) or visit the doctor during the year and are more likely to experience delays in receiving needed medical care and prescriptions than those with continuous coverage. The Medicaid program and State Children's Health Insurance Program in California both seem to have ensured levels of health care access similar to that obtained by children with year-round private coverage.
These findings highlight the benefits gained through continuous health insurance, whether public or private. Public policies should be adopted to ensure continuity of coverage and retention in public insurance programs.
许多研究记录了儿童未参保的不良后果，但对于不同时长未参保的差异影响了解较少。本研究考察了不同时长未参保（未参保1 - 4个月、5 - 11个月或全年）对儿童获得医疗服务的相对影响。
利用2005年加利福尼亚健康访谈调查儿童档案（0 - 11岁）的数据，我们估计了逻辑回归模型，以考察保险状况对6项医疗服务可及性指标的影响，并控制儿童人口统计学特征、儿童健康状况、家庭特征和城市居住情况。保险状况指标包括以下类别：（1）全年私人保险参保（参照组）；（2）全年医疗补助参保；（3）全年州儿童健康保险计划参保；（4）未参保1至4个月；（5）未参保5至11个月；（6）全年未参保；（7）全年其他保险参保。
我们发现，与持续参加私人或公共保险的儿童相比，经历短期未参保（1 - 4个月）的儿童更不太可能有固定的医疗服务来源，更有可能在需要医疗服务时出现延误。对于经历更长时间未参保的儿童，后果更糟，因为与持续参保的儿童相比，他们也更不太可能接受预防性医疗服务（儿童健康检查和流感疫苗接种）或在当年看医生，更有可能在接受所需医疗服务和处方时出现延误。加利福尼亚的医疗补助计划和州儿童健康保险计划似乎都确保了与全年参加私人保险的儿童相似的医疗服务可及水平。
这些发现凸显了持续参保（无论是公共保险还是私人保险）所带来的益处。应采取公共政策以确保保险覆盖的连续性以及在公共保险计划中的参保率。
