Newacheck Paul W, Houtrow Amy J, Romm Diane L, Kuhlthau Karen A, Bloom Sheila R, Van Cleave Jeanne M, Perrin James M
Department of Pediatrics, School of Medicine, University of California, 3333 California St, Suite 265, San Francisco, CA 94118, USA.
Pediatrics. 2009 May;123(5):e940-7. doi: 10.1542/peds.2008-2921.
Because of their elevated need for services, health insurance is particularly important for children with special health care needs. In this article we assess how well the current system is meeting the insurance needs of children with special health care needs and how emerging trends in health insurance may affect their well-being.
We begin with a review of the evidence on the impact of health insurance on the health care experiences of children with special health care needs based on the peer-reviewed literature. We then assess how well the current system meets the needs of these children by using data from 2 editions of the National Survey of Children With Special Health Care Needs. Finally, we present an analysis of recent developments and emerging trends in the health insurance marketplace that may affect this population.
Although a high proportion of children with special health care needs have insurance at any point in time, nearly 40% are either uninsured at least part of the year or have coverage that is inadequate. Recent expansions in public coverage, although offset in part by a contraction in employer-based coverage, have led to modest but significant reductions in the number of uninsured children with special health care needs. Emerging insurance products, including consumer-directed health plans, may expose children with special health care needs and their families to greater financial risks.
Health insurance coverage has the potential to secure access to needed care and improve the quality of life for these children while protecting their families from financially burdensome health care expenses. Continued vigilance and advocacy for children and youth with special health care needs are needed to ensure that these children have access to adequate coverage and that they fare well under health care reform.
由于对服务的需求增加，医疗保险对有特殊医疗需求的儿童尤为重要。在本文中，我们评估当前系统在满足有特殊医疗需求儿童的保险需求方面的表现，以及医疗保险的新趋势可能如何影响他们的福祉。
我们首先根据同行评审文献，回顾关于医疗保险对有特殊医疗需求儿童的医疗经历影响的证据。然后，我们利用两期全国有特殊医疗需求儿童调查的数据，评估当前系统在满足这些儿童需求方面的表现。最后，我们分析医疗保险市场的近期发展和新趋势，这些趋势可能会影响这一人群。
尽管在任何时候，很大比例的有特殊医疗需求的儿童都有保险，但近40%的儿童在一年中至少有一段时间没有保险，或者保险覆盖不足。近期公共保险覆盖面的扩大，尽管部分被雇主提供保险覆盖面的缩小所抵消，但已使有特殊医疗需求的未参保儿童数量略有但显著减少。包括消费者主导型健康计划在内的新兴保险产品，可能会使有特殊医疗需求的儿童及其家庭面临更大的经济风险。
医疗保险覆盖有可能确保这些儿童获得所需的医疗服务，提高他们的生活质量，同时保护他们的家庭免受经济负担沉重的医疗费用影响。需要继续对有特殊医疗需求的儿童和青少年保持警惕并进行宣传，以确保这些儿童能够获得足够的保险覆盖，并在医疗改革中表现良好。
