MMWR Morb Mortal Wkly Rep. 2010 Nov 12;59(44):1448-54.
The increasing number of persons in the United States with no health insurance has implications both for individual health and societal costs. Because of cost concerns, millions of uninsured persons forgo some needed health care, which can lead to poorer health and potentially to greater medical expenditures in the long term.
CDC analyzed data from the National Health Interview Survey (NHIS) for 2006, 2007, 2008, and 2009 and early release NHIS data from the first quarter of 2010 to determine the number of persons without health insurance or with gaps in coverage and to assess whether lack of insurance coverage was associated with increased levels of forgone health care. Data were analyzed further by demographic characteristics, family income level, and selected chronic conditions.
In the first quarter of 2010, an estimated 59.1 million persons had no health insurance for at least part of the year before their interview, an increase from 58.7 million in 2009 and 56.4 million in 2008. Of the 58.7 million in 2009, 48.6 million (82.8%) were aged 18-64 years. Among persons aged 18-64 years with family incomes two to three times the federal poverty level (approximately $43,000-$65,000 for a family of four in 2009), 9.7 million (32.1%) were uninsured for at least part of the preceding year. Persons aged 18-64 years with no health insurance during the preceding year were seven times as likely (27.6% versus 4.0%) as those continuously insured to forgo needed health care because of cost. Among persons aged 18-64 years with diabetes mellitus, those who had no health insurance during the preceding year were six times as likely (47.5% versus 7.7%) to forgo needed medical care as those who were continuously insured.
An increasing number of persons in the United States, including those at middle income levels, have had periods with no health insurance coverage in recent years, which is associated with increased levels of forgone health care. Persons aged 18-64 years with chronic conditions and without consistent health insurance coverage are much more likely to forgo needed medical care than persons with the same conditions and continuous coverage.
Increasing the number of persons with continuous health insurance coverage can reduce the number of occasions that persons forgo needed health care, which can reduce complications from illness and avoidable long-term expenditures.
在美国，没有医疗保险的人数不断增加，这对个人健康和社会成本都有影响。由于成本问题，数百万未参保人员放弃了一些必要的医疗保健，这可能导致健康状况恶化，并在长期内导致医疗支出增加。
CDC 分析了 2006 年、2007 年、2008 年和 2009 年全国健康访谈调查（NHIS）以及 2010 年第一季度 NHIS 早期发布数据，以确定没有医疗保险或保险覆盖有缺口的人数，并评估是否缺乏医疗保险与增加的医疗保健服务放弃水平有关。数据还按人口统计学特征、家庭收入水平和选定的慢性疾病进一步进行了分析。
2010 年第一季度，估计有 5910 万人在接受采访前至少有一年没有医疗保险，比 2009 年的 5870 万人和 2008 年的 5640 万人有所增加。在 2009 年的 5870 万人中，4860 万人（82.8%）年龄在 18-64 岁之间。在家庭收入为联邦贫困水平的两倍到三倍（2009 年四口之家约为 43,000-65,000 美元）的 18-64 岁人群中，有 970 万人（32.1%）至少有一年的部分时间没有医疗保险。在过去一年中没有医疗保险的 18-64 岁人群中，由于费用原因放弃必要医疗保健的可能性是连续参保人群的七倍（27.6%比 4.0%）。在 18-64 岁患有糖尿病的人群中，与连续参保的人群相比，过去一年没有医疗保险的人群放弃必要医疗护理的可能性是其六倍（47.5%比 7.7%）。
近年来，越来越多的美国人，包括那些处于中等收入水平的人，都有一段时间没有医疗保险，这与医疗保健服务放弃率的增加有关。与有连续医疗保险的人相比，患有慢性疾病且没有持续医疗保险的 18-64 岁人群更有可能放弃必要的医疗护理。
增加连续医疗保险覆盖人数可以减少人们放弃必要医疗保健的次数，从而减少疾病并发症和避免长期支出。
