Choi Miji, Sommers Benjamin D, McWilliams J Michael
Harvard School of Public Health, Boston, MA, USA.
J Health Care Poor Underserved. 2011 May;22(2):576-89. doi: 10.1353/hpu.2011.0041.
OBJECTIVE/METHODS: We used national data from the Medical Expenditure Panel Survey and multivariate linear spline regression models to compare trends in children's health insurance coverage and access to care by income and race/ethnicity during (1998-2002) and after (2002-2006) major expansions of state insurance programs.
During expansions, coverage and access for children in low-income and middle-income families improved, but these gains ceased thereafter for middle-income children, most of whom remained ineligible for public insurance. Racial and ethnic differences narrowed from 1998-2002, but persisted-and in at least one case tended to widen-from 2002-2006. Non-White children in families with incomes above most states' eligibility thresholds experienced significant declines in coverage and access to care after 2002.
Gains in children's coverage and access to care during CHIP expansions have since stagnated or even reversed for some groups. Recent legislation to expand coverage for uninsured children (the PPACA of 2010) may redress these adverse changes in trends.
目的/方法：我们使用了医疗支出小组调查的全国数据以及多元线性样条回归模型，以比较在州保险计划大幅扩张期间（1998 - 2002年）及之后（2002 - 2006年），不同收入水平和种族/族裔的儿童在医疗保险覆盖范围及获得医疗服务方面的趋势。
在扩张期间，低收入和中等收入家庭儿童的保险覆盖范围及获得医疗服务的机会有所改善，但此后中等收入儿童的这些改善停止了，他们中的大多数人仍无资格获得公共保险。种族和族裔差异在1998 - 2002年有所缩小，但在2002 - 2006年持续存在，并且至少在一种情况下有扩大的趋势。2002年之后，收入高于大多数州资格门槛家庭中的非白人儿童在保险覆盖范围和获得医疗服务方面出现了显著下降。
儿童健康保险计划（CHIP）扩张期间儿童在保险覆盖范围和获得医疗服务方面的改善，此后对一些群体而言出现了停滞甚至逆转。最近旨在扩大未参保儿童保险覆盖范围的立法（2010年《患者保护与平价医疗法案》）可能会纠正这些不利的趋势变化。
