Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD 20850, USA.
Acad Pediatr. 2013 May-Jun;13(3):191-203. doi: 10.1016/j.acap.2013.02.003. Epub 2013 Feb 9.
To examine trends in children's health access, utilization, and expenditures over time (2002-2009) by race/ethnicity, income, and insurance status/expected payer.
Data include a nationally representative random sample of children in the United States in 2002-2009 from the Medical Expenditure Panel Survey (MEPS) and a nationwide sample of pediatric hospitalizations in 2005 and 2009 from the Healthcare Cost and Utilization Project (HCUP).
The percentage of children with private insurance coverage declined from 65.3% in 2002 to 60.6% in 2009. At the same time, the percentage of publicly insured children increased from 27.0% in 2002 to 33.1% in 2009. Fewer children reported being uninsured in 2009 (6.3%) compared to 2002 (7.7%). The most significant progress was for Hispanic children, for whom the percentage of uninsured dropped from 15.0% in 2002 to 10.3% in 2009. The uninsured were consistently the least likely to have access to a usual source of care, and this disparity remained unchanged in 2009. Non-Hispanic whites were most likely to report a usual source of care in both 2002 and 2009. The percentage of children with a doctor visit improved for whites and Hispanics (2009 vs 2002). In contrast, black children saw no improvement during this time period. Between 2002 and 2009, children's average total health care expenditures increased from $1294 to $1914. Average total expenditures nearly doubled between 2002 and 2009 for white children with private health insurance. Among infants, hospitalizations for pneumonia decreased in absolute number (41,000 to 34,000) and as a share of discharges (0.8% to 0.7%). Fluid and electrolyte disorders also decreased over time. Influenza appeared only in 2009 in the list of top 15 diagnoses with 11,000 hospitalization cases. For children aged 1 to 17, asthma hospitalization increased in absolute number (from 119,000 to 134,000) and share of discharges (6.6% to 7.6%). Skin infections appeared in the top 15 categories in 2009, with 57,000 cases (3.3% of total).
Despite significant improvement in insurance coverage, disparities by race/ethnicity and income persist in access to and use of care. Hispanic children experienced progress in a number of measures, while black children did not. Because racial/ethnic and socioeconomic disparities are often reported as single cross-sectional studies, our approach is innovative and improves on prior studies by examining population trends during the time period 2002-2009. Our study sheds light on children's disparities during the most recent economic crisis.
按种族/族裔、收入和保险状况/预期支付方考察儿童获得医疗服务、利用医疗服务和医疗支出的趋势随时间的变化（2002-2009 年）。
数据包括 2002-2009 年来自医疗支出调查（MEPS）的美国全国代表性随机儿童样本和 2005 年和 2009 年来自医疗保健成本与利用项目（HCUP）的全国儿科住院样本。
有私人保险的儿童比例从 2002 年的 65.3%下降到 2009 年的 60.6%。与此同时，有公共保险的儿童比例从 2002 年的 27.0%上升到 2009 年的 33.1%。2009 年未参保的儿童比例（6.3%）较 2002 年（7.7%）有所下降。进步最显著的是西班牙裔儿童，未参保比例从 2002 年的 15.0%下降到 2009 年的 10.3%。未参保儿童始终最不可能获得常规医疗服务，这种差距在 2009 年没有改变。非西班牙裔白人在 2002 年和 2009 年都最有可能报告有常规医疗服务来源。有医生就诊的儿童比例白人有所增加，西班牙裔也有所增加（2009 年与 2002 年相比）。相比之下，黑人儿童在此期间没有任何改善。2002 年至 2009 年期间，儿童的平均总医疗保健支出从 1294 美元增加到 1914 美元。在 2002 年至 2009 年期间，有私人健康保险的白人儿童的总支出几乎翻了一番。在婴儿中，肺炎住院人数绝对减少（41000 降至 34000），占出院人数的比例也从 0.8%降至 0.7%。液体和电解质紊乱也随着时间的推移而减少。流感在 2009 年才首次出现在前 15 种诊断的名单中，有 11000 例住院病例。对于 1 至 17 岁的儿童，哮喘住院人数绝对增加（从 119000 增加到 134000），占出院人数的比例也从 6.6%增加到 7.6%。皮肤感染在 2009 年进入前 15 个类别，有 57000 例（占总数的 3.3%）。
尽管保险覆盖范围有了显著改善，但在获得和使用医疗服务方面，种族/族裔和收入方面的差异仍然存在。西班牙裔儿童在许多方面取得了进展，而黑人儿童则没有。由于种族/族裔和社会经济差异通常作为单一的横断面研究报告，我们的方法具有创新性，通过考察 2002-2009 年期间的人口趋势，改进了以往的研究。我们的研究揭示了最近经济危机期间儿童的差异。
