Social and Scientific Systems, Silver Spring, Maryland, USA.
Health Aff (Millwood). 2013 Mar;32(3):508-15. doi: 10.1377/hlthaff.2012.0691.
A goal of federal policy is to improve preventive health care for children. However, little is known about how adherence to recommendations by the American Academy of Pediatrics for well-child visits has changed over time. Using the 1996-2008 Medical Expenditure Panel Surveys, we examined trends in adherence and whether differences across population subgroups narrowed or widened over time. We found that the ratio of actual to recommended well-child visits rose from 46.3 percent during the 1996-98 time period to 58.9 percent during the 2007-08 time period. Although this increase in adherence is important, improvement occurred unevenly. We observed large differences in adherence at the start of the study period across income, race or ethnicity, parent education, region, insurance coverage, and having a usual source of care. None of these differences had narrowed significantly by the end of the study period. Indeed, differences widened across parent education, between those with and without insurance coverage, by usual source of care, and between the Northeast and the Midwest and West regions. Our results highlight the importance of provisions in the Affordable Care Act to expand coverage, strengthen incentives for preventive services, and improve the measurement of preventive services.
联邦政策的目标之一是改善儿童的预防保健。然而，人们对于美国儿科学会推荐的儿童健康检查的依从性如何随时间而变化知之甚少。本研究使用 1996-2008 年的医疗支出调查（Medical Expenditure Panel Surveys），考察了依从性的趋势，以及人口亚组之间的差异是否随时间缩小或扩大。结果发现，实际接受推荐的儿童健康检查的比例从 1996-98 年期间的 46.3%上升到 2007-08 年期间的 58.9%。尽管这种依从性的提高很重要，但改善是不均衡的。我们在研究开始时观察到，在收入、种族或民族、父母教育、地区、保险覆盖范围以及是否有常规医疗服务提供者方面，依从性存在很大差异。到研究结束时，这些差异没有明显缩小。事实上，在父母教育、保险覆盖范围、常规医疗服务提供者以及东北部、中西部和西部地区之间，差异都在扩大。我们的研究结果突出了《平价医疗法案》在扩大覆盖范围、加强预防服务激励措施以及改善预防服务衡量方面的重要性。
