Currie Janet
Columbia University, National Bureau of Economic Research, Department of Economics, 420 W 118th St, New York, NY 10027, USA.
Pediatrics. 2009 Nov;124 Suppl 3:S246-54. doi: 10.1542/peds.2009-1100M.
A full accounting of the excess burden of poor health in childhood must include any continuing loss of productivity over the life course. Including these costs results in a much higher estimate of the burden than focusing only on medical costs and other shorter-run costs to parents (such as lost work time). Policies designed to reduce this burden must go beyond increasing eligibility for health insurance, because disparities exist not only in access to health insurance but also in take-up of insurance, access to care, and the incidence of health conditions. We need to create a comprehensive safety net for young children that includes automatic eligibility for basic health coverage under Medicaid unless parents opt out by enrolling children in a private program; health and nutrition services for pregnant women and infants; quality preschool; and home visiting for infants and children at risk. Such a program is feasible and would be relatively inexpensive.
对儿童健康不佳所带来的额外负担进行全面核算，必须涵盖一生中持续存在的生产力损失。将这些成本纳入考量，会使负担的估计值比仅关注医疗成本和父母的其他短期成本（如误工时间）要高得多。旨在减轻这一负担的政策必须超越提高医疗保险资格的范畴，因为差距不仅存在于医疗保险的获取方面，还存在于保险的参保率、医疗服务的可及性以及健康状况的发生率方面。我们需要为幼儿建立一个全面的安全网，包括除非父母选择让孩子参加私人项目而退出，否则自动获得医疗补助计划下的基本医疗保险资格；为孕妇和婴儿提供健康和营养服务；优质的学前教育；以及对有风险的婴儿和儿童进行家访。这样一个项目是可行的，而且成本相对较低。
