Coates Ralph J, Ogden Lydia, Monroe Judith A, Buehler James, Yoon Paula W, Collins Janet L
Public Health Surveillance and Informatics Program Office, Office of Surveillance, Epidemiology, and Laboratory Services, CDC, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
MMWR Suppl. 2012 Jun 15;61(2):73-8.
The findings described in this supplement can help improve collaboration among public health and other stakeholders who influence population health, including employers, health plans, health professionals, and voluntary associations, to increase the use of a set of clinical preventive services that, with improved use, can substantially reduce morbidity and mortality in the U.S. adult population. This supplement highlighted that the use of the clinical preventive services in the U.S. adult population is not optimal and is quite variable, ranging from approximately 10% to 85%, depending on the particular service. Use was particularly low for tobacco cessation, aspirin use to reduce risk of cardiovascular disease, and influenza vaccination; however, ample opportunity exists to improve use of all of these services. Among the specific populations least likely to have used the recommended services, persons with no insurance, no usual source of care, or no recent use of the health-care system (if included in the analysis) were the groups least likely to have used the services. Use among the uninsured was generally 10 to 30 percentage points below the general population averages, suggesting that improvements in insurance coverage are likely to increase use of these clinical preventive services. A randomized, controlled trial of an expansion of Medicaid coverage by Oregon in 2008 supports this hypothesis by demonstrating improved use of clinical services with increased health insurance coverage. A recent survey among the uninsured found a low level of awareness of the provisions of the Patient Protection and Affordable Care Act of 2010 as amended by the Healthcare and Education Reconciliation Act of 2010 (referred to collectively as the Affordable Care Act [ACA]). Therefore, improving opportunities for coverage might be insufficient, and focused efforts by governmental health agencies and other stakeholders are likely to be needed to enroll uninsured persons in health plans. In addition, although use of the preventive services in insured populations was greater than among the uninsured, use among the insured was generally <75%, and often much less. Therefore, having health insurance coverage might not itself be sufficient to optimize use of clinical preventive services, and additional measures to improve use are likely to be necessary.
本增刊中描述的研究结果有助于改善公共卫生部门与其他影响人群健康的利益相关者之间的合作，这些利益相关者包括雇主、健康计划机构、卫生专业人员和志愿协会，以增加一系列临床预防服务的使用。如果能更好地利用这些服务，就能大幅降低美国成年人口的发病率和死亡率。本增刊强调，美国成年人口对临床预防服务的使用并不理想，而且差异很大，根据具体服务的不同，使用率在大约10%至85%之间。戒烟、使用阿司匹林降低心血管疾病风险以及流感疫苗接种的使用率特别低；然而，改善所有这些服务的使用情况仍有很大空间。在最不可能使用推荐服务的特定人群中，没有保险、没有固定医疗服务来源或近期未使用过医疗保健系统的人（如果纳入分析）是最不可能使用这些服务的群体。未参保人群的使用率通常比总体人群平均水平低10至30个百分点，这表明扩大保险覆盖范围可能会增加这些临床预防服务的使用。俄勒冈州2008年进行的一项关于扩大医疗补助覆盖范围的随机对照试验证明，随着医疗保险覆盖范围的增加，临床服务的使用情况得到改善，从而支持了这一假设。最近一项针对未参保人群的调查发现，他们对经《2010年医疗保健与教育协调法案》修订的《2010年患者保护与平价医疗法案》（统称为《平价医疗法案》[ACA]）条款的知晓程度较低。因此，仅仅增加参保机会可能并不够，政府卫生机构和其他利益相关者可能需要做出针对性努力，以使未参保人员加入健康计划。此外，虽然参保人群对预防服务的使用率高于未参保人群，但参保人群的使用率普遍<75%，而且往往低得多。因此，仅仅拥有医疗保险覆盖范围本身可能不足以实现临床预防服务的最佳使用，可能还需要采取其他措施来提高使用率。
