Songer T J, LaPorte R E, Dorman J S, Orchard T J, Becker D J, Drash A L
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261.
Diabetes Care. 1991 Apr;14(4):318-24. doi: 10.2337/diacare.14.4.318.
To determine whether people with insulin-dependent diabetes mellitus (IDDM) were compromised in their access to insurance.
A case-control study of 158 people with IDDM and 158 nondiabetic siblings matched for age and sex was conducted to evaluate the health, life, and automobile insurance characteristics and history of people with IDDM.
Health insurance coverage (yes/no) among the IDDM and sibling control subjects was similar. More than 90% of the IDDM and control respondents had insurance through a private third-party source, and this insurance did not differ by type of plan, coverage, or premium. However, Medicare coverage was more common among the IDDM subjects and was associated with the presence of severe diabetic complications. IDDM subjects were also more likely to have been denied a health insurance policy by an insurer than were the control subjects (23 vs. 1%, P less than 0.001). Similarly, there was no difference between the IDDM and sibling control subjects in the number who had a life or automobile insurance policy. However, life and automobile insurance refusal was much more frequent among the IDDM respondents, more so for life (55 vs. 0%, P less than 0.001) than for automobile (12 vs. 4%, P less than 0.05) insurance.
These results suggest that access to insurance is severely compromised for people with IDDM. Although most of those with IDDM are able to find some form of insurance, it is evident that on average they must go to extra lengths to find it. These data and a changing insurance environment emphasize the need to reexamine, as a society, the importance of insurance for people with chronic disease, particularly IDDM.
确定胰岛素依赖型糖尿病（IDDM）患者在获取保险方面是否受到阻碍。
进行了一项病例对照研究，选取158例IDDM患者及158例年龄和性别相匹配的非糖尿病同胞，以评估IDDM患者的健康、人寿和汽车保险特征及历史。
IDDM患者组和同胞对照组的医疗保险覆盖情况（是/否）相似。超过90%的IDDM患者和对照受访者通过私人第三方渠道获得保险，且这种保险在计划类型、覆盖范围或保费方面并无差异。然而，医疗保险在IDDM患者中更为常见，且与严重糖尿病并发症的存在相关。IDDM患者被保险公司拒绝医疗保险政策的可能性也高于对照组（23%对1%，P<0.001）。同样，IDDM患者组和同胞对照组在拥有人寿或汽车保险政策的人数上没有差异。然而，IDDM受访者中人寿和汽车保险被拒的情况更为频繁，人寿保险方面（55%对0%，P<0.001）比汽车保险方面（12%对4%，P<0.05）更明显。
这些结果表明，IDDM患者在获取保险方面受到严重阻碍。尽管大多数IDDM患者能够找到某种形式的保险，但显然平均而言他们必须付出更多努力才能获得。这些数据以及不断变化的保险环境强调了作为一个社会重新审视慢性病患者，特别是IDDM患者保险重要性的必要性。
