Honberg Lynda E, Kogan Michael D, Allen Deborah, Strickland Bonnie B, Newacheck Paul W
Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland 20857, USA.
Pediatrics. 2009 Nov;124(5):1273-80. doi: 10.1542/peds.2009-0372. Epub 2009 Oct 12.
This article reports findings from the 2005-2006 National Survey of Children With Special Health Care Needs (NS-CSHCN) regarding the extent to which CSHCN have access to public or private health insurance that meets their needs.
The HRSA Maternal and Child Health Bureau's health insurance core outcome was measured on the basis of whether a child had public or private coverage at the time of survey; continuity of coverage during the previous 12 months; and adequacy of coverage. Bivariate and multivariate statistical methods were used to assess independent predictors of respondents who met the health insurance core outcome and the impact of meeting the core outcome on measures of access and financial burden. Comparisons with a referent sample of children who did and did not have special needs and were included in the 2001 NS-CSHCN are also presented.
A total of 62.0% of CSHCN nationally met the health insurance core outcome in 2005-2006, up from 59.6% in 2001. Disparities by ethnicity and income remain, but some have narrowed, especially for Hispanic CSHCN. Children who did not meet the health insurance core outcome were more likely to have unmet needs and their families to experience financial problems. CSHCN were more likely to be insured than children without special needs but less likely to be adequately insured.
Results of the survey demonstrate that although a growing number of CSHCN have continuous and adequate health insurance, additional effort is needed to improve the adequacy of that insurance, particularly for children in vulnerable subpopulations.
本文报告了2005 - 2006年全国特殊医疗需求儿童调查（NS-CSHCN）的结果，内容涉及有特殊医疗需求的儿童获得满足其需求的公共或私人医疗保险的程度。
卫生资源与服务管理局母婴健康局的医疗保险核心结果是根据儿童在调查时是否拥有公共或私人保险、过去12个月的保险连续性以及保险充足性来衡量的。采用双变量和多变量统计方法来评估符合医疗保险核心结果的受访者的独立预测因素，以及达到核心结果对获得医疗服务和经济负担衡量指标的影响。还展示了与2001年NS-CSHCN中包含的有特殊需求和无特殊需求儿童的参考样本的比较。
2005 - 2006年，全国共有62.0%的有特殊医疗需求的儿童符合医疗保险核心结果，高于2001年的59.6%。种族和收入方面的差距仍然存在，但有些差距已经缩小，尤其是西班牙裔有特殊医疗需求的儿童。未达到医疗保险核心结果的儿童更有可能有未满足的需求，其家庭也更有可能经历经济问题。有特殊医疗需求的儿童比无特殊需求的儿童更有可能获得保险，但获得充分保险的可能性较小。
调查结果表明，尽管越来越多有特殊医疗需求的儿童拥有持续且充足的医疗保险，但仍需做出更多努力来提高保险的充足性，特别是对于弱势群体中的儿童。
