Department of Psychology, University of Arizona, Tucson, AZ, USA.
Am J Public Health. 2011 Aug;101(8):1437-43. doi: 10.2105/AJPH.2010.300080. Epub 2011 Jun 16.
We examined the impact of health insurance status on medical debt among Arizona residents and the impact of both of these factors on access to care.
We estimated logistic regression models for medical debt (problems paying and currently paying medical bills) and access to care (medical care and medications delayed or missed because of cost or lack of insurance).
Insured status did not predict medical debt after control for health status, income, age, and household characteristics. Insured status (adjusted odds ratio [AOR] = 0.32), problems paying medical bills (AOR = 4.96), and currently paying off medical bills (AOR = 3.04) were all independent predictors of delayed medical care, but only problems paying (AOR = 6.16) and currently paying (AOR = 3.68) medical bills predicted delayed medications. Inconsistent coverage, however, was a strong predictor of problems paying bills, and both of these factors led to delays in medical care and medications.
At least in Arizona, health insurance does not protect individuals from medical debt, and medical debt and lack of insurance coverage both predict reduced access to care. These results may represent a troubling message for US health care in general.
我们研究了亚利桑那州居民的医疗保险状况对医疗债务的影响，以及这两个因素对获得医疗服务的影响。
我们对医疗债务（支付问题和当前支付医疗账单）和获得医疗服务（医疗和药物因费用或缺乏保险而延迟或错过）进行了逻辑回归模型估计。
在控制健康状况、收入、年龄和家庭特征后，保险状况并未预测医疗债务。保险状况（调整后的优势比 [AOR]=0.32）、支付医疗账单的问题（AOR=4.96）和当前偿还医疗账单（AOR=3.04）均为延迟医疗服务的独立预测因素，但仅支付医疗账单的问题（AOR=6.16）和当前支付（AOR=3.68）预测了药物的延迟。然而，保险覆盖范围不一致是支付账单问题的一个强烈预测因素，这两个因素都导致了医疗服务和药物的延迟。
至少在亚利桑那州，医疗保险并不能保护个人免受医疗债务的影响，医疗债务和缺乏保险都预示着获得医疗服务的机会减少。这些结果可能代表了对美国整体医疗保健的一个令人不安的信息。
