Department of Social Work, State University of New York at Binghamton, Binghamton, NY 13902-6000, USA.
Gerontologist. 2011 Apr;51(2):156-69. doi: 10.1093/geront/gnq064. Epub 2010 Aug 6.
This longitudinal study examined the role of health insurance in access to health care among older immigrants.
Using data from the Second Longitudinal Study of Aging, the longitudinal trajectories of having a usual source of care were compared between 3 groups (all 70+ years): (a) late-life immigrants with less than 15 years of residence in the United States ("recent immigrants"; n = 133), (b) "earlier immigrants" (15 years or longer in the United States, n = 672), and (c) U.S. born (n = 8,642). A series of hierarchical generalized linear models were run to test the mediating relationship of health insurance between immigrant status and having a usual source of care.
Although the probabilities of having a usual source of care increased over time across all three groups, recent immigrants were less likely to have Medicare and private insurance over time; this in turn was related to lower probabilities of having a usual source of care (indirect relationship). There was no direct relationship between immigrant status and having a usual source of care.
To prevent the use of more expensive forms of care in the long run, policy efforts should expand late-life immigrants' health insurance coverage by increasing affordable health insurance options.
本纵向研究考察了医疗保险在老年移民获得医疗保健方面的作用。
利用第二次老龄化纵向研究的数据，比较了三组（均为 70 岁以上）人群中拥有常规医疗服务来源的纵向轨迹：（a）在美国居住不到 15 年的“近期移民”（n=133）；（b）“早期移民”（在美国居住 15 年或以上，n=672）；（c）美国出生（n=8642）。采用一系列分层广义线性模型检验了医疗保险在移民身份与常规医疗服务来源之间的中介关系。
尽管三组人群的常规医疗服务来源的可能性随着时间的推移而增加，但近期移民获得医疗保险和私人保险的可能性随着时间的推移而降低；这反过来又与常规医疗服务来源的可能性降低有关（间接关系）。移民身份与常规医疗服务来源之间没有直接关系。
为了防止长期内使用更昂贵的医疗服务形式，政策努力应通过增加负担得起的医疗保险选择来扩大老年移民的医疗保险覆盖范围。
