Mongan Institute for Health Policy, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, MA 02114, USA.
Disabil Health J. 2011 Oct;4(4):238-44. doi: 10.1016/j.dhjo.2011.06.001. Epub 2011 Sep 6.
Despite social "safety net" programs, many U.S. residents with disabilities lack insurance coverage and thus risk financial barriers to accessing care. The study objectives were to characterize working-age adults with disabilities who lack health insurance and to examine their self-reported barriers to care.
The authors conducted analyses of nationally representative Medical Expenditure Panel Survey data from 2000 through 2006.
During this time period, 14.8% of working-age U.S. residents lacked health insurance, including 11.6% of persons with disabilities. Focusing only on uninsured individuals, persons with disabilities were significantly (p = .001) more likely than those without disabilities to have a usual source of care. However, on 6 other access measures (those that comprised our composite indicator of access barriers), uninsured persons with disabilities reported barriers significantly (p = .001) more often than did individuals without disabilities: 36.0% of uninsured persons with disabilities reported being unable to get necessary medical care, compared with 9.5% of uninsured, nondisabled persons; and 26.9% of uninsured persons with disabilities reported being unable to get necessary medications, compared with 5.3% of uninsured individuals without disabilities. Having a cognitive impairment produced the largest adjusted odds ratio (AOR) of reporting any access barrier (1.64, 95% CI 144-1.87), while having lower body functional limitations or hearing deficits also produced relatively high AORs (1.47, 1.32-1.65 and 1.48, 1.11-1.98, respectively).
Uninsured individuals with disabilities confront significantly more barriers to accessing care than do nondisabled persons without health insurance. Certain types of disabilities appear especially associated with experiencing access barriers, suggesting areas requiring particular attention.
尽管有社会“安全网”计划，但许多美国残疾居民缺乏保险覆盖，因此面临获得医疗服务的经济障碍。本研究旨在描述没有医疗保险的残疾工作年龄成年人，并研究他们报告的护理障碍。
作者分析了 2000 年至 2006 年期间具有全国代表性的医疗支出面板调查数据。
在此期间，14.8%的美国工作年龄居民没有医疗保险，其中包括 11.6%的残疾居民。仅关注未参保人群，残疾居民与非残疾居民相比，有常规医疗服务来源的可能性显著更高（p =.001）。然而，在其他 6 项获取医疗服务的措施上（这些措施构成了我们获取障碍综合指标），未参保残疾居民报告障碍的比例显著更高（p =.001）：36.0%的未参保残疾居民表示无法获得必要的医疗护理，而非残疾未参保居民这一比例为 9.5%；26.9%的未参保残疾居民表示无法获得必要的药物，而非残疾未参保居民这一比例为 5.3%。认知障碍患者报告存在任何获取障碍的调整后优势比（AOR）最大（1.64，95%CI 1.44-1.87），而身体功能障碍较轻或听力缺陷患者的 AOR 也相对较高（1.47，1.32-1.65 和 1.48，1.11-1.98）。
没有医疗保险的残疾居民在获取医疗服务方面面临着比没有医疗保险的非残疾居民更多的障碍。某些类型的残疾似乎与获取医疗服务障碍特别相关，这表明这些领域需要特别关注。
