Sarah A. Burgard is with the Departments of Sociology and Epidemiology, University of Michigan, Ann Arbor. Jaclynn M. Hawkins is with the Departments of Sociology and Social Work, University of Michigan.
Am J Public Health. 2014 Feb;104(2):e134-40. doi: 10.2105/AJPH.2013.301512. Epub 2013 Dec 12.
This study assessed possible associations between recessions and changes in the magnitude of social disparities in foregone health care, building on previous studies that have linked recessions to lowered health care use.
Data from the 2006 to 2010 waves of the National Health Interview Study were used to examine levels of foregone medical, dental and mental health care and prescribed medications. Differences by race/ethnicity and education were compared before the Great Recession of 2007 to 2009, during the early recession, and later in the recession and in its immediate wake.
Foregone care rose for working-aged adults overall in the 2 recessionary periods compared with the pre-recession. For multiple types of pre-recession care, foregoing care was more common for African Americans and Hispanics and less common for Asian Americans than for Whites. Less-educated individuals were more likely to forego all types of care pre-recession. Most disparities in foregone care were stable during the recession, though the African American-White gap in foregone medical care increased, as did the Hispanic-White gap and education gap in foregone dental care.
Our findings support the fundamental cause hypothesis, as even during a recession in which more advantaged groups may have had unusually high risk of losing financial assets and employer-provided health insurance, they maintained their relative advantage in access to health care. Attention to the macroeconomic context of social disparities in health care use is warranted.
本研究在前瞻性研究将经济衰退与医疗保健利用减少相关联的基础上，评估衰退与已放弃的医疗保健的社会差异幅度变化之间可能存在的关联。
使用 2006 年至 2010 年全国健康访谈研究的资料，检查错失的医疗、牙科和精神保健以及处方药物的水平。在 2007 年至 2009 年大衰退之前、经济衰退早期以及衰退后期和紧随其后的时期，按种族/民族和教育程度比较差异。
与衰退前相比，在两次衰退期间，所有年龄段的劳动年龄成年人的已放弃的医疗保健均有所增加。在多种类型的衰退前保健中，与白人相比，非裔美国人和西班牙裔人更有可能放弃保健，而亚裔美国人则更少。在衰退前，教育程度较低的人更有可能放弃所有类型的保健。尽管在医疗保健方面，非裔美国人与白人之间的差距有所扩大，西班牙裔人与白人之间以及牙科保健方面的教育差距也有所扩大，但在经济衰退期间，大多数已放弃的保健服务差异保持稳定。
我们的发现支持了根本原因假说，即在经济衰退期间，即使更有利的群体可能面临失去金融资产和雇主提供的健康保险的异常高风险，他们也能保持其在获得医疗保健方面的相对优势。有必要关注医疗保健利用方面的社会差异的宏观经济背景。
