Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Madison, WI 53726, USA.
Pediatrics. 2012 Dec;130(6):1027-37. doi: 10.1542/peds.2012-0668. Epub 2012 Nov 5.
We sought to determine how health care-related financial burden, childhood activity limitations, health insurance, and other access-related factors predict delayed or forgone care for families with children, using a nationally representative, population-based sample.
Our sample included families with children aged 0 to 17 years whose family was interviewed about their health care expenditures in 1 of 7 panels of the 2001 to 2008 Medial Expenditure Panel Survey (N = 14 138). Financial burden was defined as (1) the sum of out-of-pocket health service expenditures during the first survey year and (2) that sum divided by adjusted family income. Delayed or forgone care was defined as self-report of delayed or forgone medical care or prescription medications for the reference parent or child during the second survey year.
Financial burden, discordant insurance, and having a child with an activity limitation were some of the strongest predictors of delayed or forgone care. Additionally, significant health insurance and income-related disparities exist in the experience of delayed or forgone care.
Children and their families are delaying or forgoing needed care due to health care-related financial burden. Policies are needed to effectively reduce financial burden and improve the concordance of insurance between parents and children because this may reduce the frequency of unmet need among families. Moreover, reducing the occurrence of delayed or forgone care may improve health outcomes by increasing the opportunity to receive timely and preventive care.
本研究旨在利用全国代表性的人群样本，确定医疗相关经济负担、儿童活动受限、医疗保险及其他与获得医疗服务相关的因素，对有儿童的家庭延迟或放弃医疗服务的情况进行预测。
本研究样本包括年龄 0 至 17 岁儿童的家庭，其家庭在 2001 至 2008 年的 Medial Expenditure Panel Survey（MEPS）的 7 个面板之一中接受了关于其医疗支出的访谈（N=14138）。经济负担定义为：（1）第一年调查中自付的医疗服务支出总和，以及（2）该总和除以调整后的家庭收入。延迟或放弃医疗服务定义为：在第二年调查中，参考父母或儿童自我报告的延迟或放弃医疗护理或处方药物。
经济负担、保险不一致和儿童活动受限是导致延迟或放弃医疗服务的一些最强预测因素。此外，在经历延迟或放弃医疗服务方面，确实存在显著的医疗保险和收入相关差异。
儿童及其家庭因医疗相关经济负担而延迟或放弃必要的医疗服务。需要制定政策来有效减轻经济负担，并提高父母和子女之间医疗保险的一致性，因为这可能会减少家庭未满足的医疗服务需求的频率。此外，减少延迟或放弃医疗服务的发生可能会通过增加及时和预防性护理的机会来改善健康结果。
