Ghandour Reem M, Comeau Meg, Tobias Carol, Dworetzky Beth, Hamershock Rose, Honberg Lynda, Mann Marie Y, Bachman Sara S
US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology and Research, Division of Epidemiology, Rockville, Md.
Catalyst Center, Health and Disability Working Group, Boston University School of Public Health, Boston, Mass.
Acad Pediatr. 2015 Jul-Aug;15(4):451-60. doi: 10.1016/j.acap.2015.02.002. Epub 2015 Apr 10.
To report on coverage and adequacy of health insurance for children with special health care needs (CSHCN) in 2009-2010 and assess changes since 2001.
Data were from the National Survey of Children with Special Health Care Needs (NS-CSHCN), a random-digit telephone survey with 40,243 (2009-2010) and 38,866 (2001) completed interviews. Consistency and adequacy of insurance was measured by: 1) coverage status, 2) gaps in coverage, 3) coverage of needed services, 4) reasonableness of uncovered costs, and 5) ability to see needed providers, as reported by parents. Bivariate and multivariable analyses were conducted to assess factors associated with adequate insurance coverage in 2009-2010. Unadjusted and adjusted prevalence estimates were examined to identify changes in the type of insurance coverage and the proportion of CSHCN with adequate coverage by insurance type.
The proportion of CSHCN with private coverage decreased from 64.7% to 50.7% between 2001 and 2009-2010, while public coverage increased from 21.7% to 34.7%; the proportion of CSHCN without any insurance declined from 5.2% to 3.5%. The proportion of CSHCN with adequate coverage varied over time and by insurance type: among privately covered CSHCN, the proportion with adequate coverage declined (62.6% to 59.6%), while among publicly covered CSHCN, the proportion with adequate insurance increased (63.0% to 70.7%). Publicly insured CSHCN experienced improvements in each of the 3 adequacy components.
There has been a continued shift from private to public coverage, which is more affordable, offers benefits that are more likely to meet CSHCN needs, and allowed CSHCN to see necessary providers.
报告2009 - 2010年有特殊医疗需求儿童（CSHCN）的医疗保险覆盖范围和充足性，并评估自2001年以来的变化。
数据来自全国有特殊医疗需求儿童调查（NS - CSHCN），这是一项随机数字电话调查，2009 - 2010年完成访谈40243例，2001年完成访谈38866例。保险的一致性和充足性通过以下方面衡量：1）覆盖状况，2）覆盖缺口，3）所需服务的覆盖情况，4）未覆盖费用的合理性，以及5）家长报告的看所需医疗服务提供者的能力。进行双变量和多变量分析以评估2009 - 2010年与充足保险覆盖相关的因素。检查未调整和调整后的患病率估计值，以确定保险覆盖类型的变化以及不同保险类型下有充足保险覆盖的CSHCN比例的变化。
2001年至2009 - 2010年期间，有私人保险覆盖的CSHCN比例从64.7%降至50.7%，而公共保险覆盖比例从21.7%增至34.7%；无任何保险的CSHCN比例从5.2%降至3.5%。有充足保险覆盖的CSHCN比例随时间和保险类型而变化：在有私人保险覆盖的CSHCN中，有充足保险覆盖的比例下降（从62.6%降至59.6%），而在有公共保险覆盖的CSHCN中，有充足保险的比例上升（从63.0%升至70.7%）。有公共保险的CSHCN在三个充足性组成部分中的每一项都有所改善。
保险覆盖已持续从私人保险转向公共保险，公共保险更经济实惠，提供的福利更有可能满足CSHCN的需求，并使CSHCN能够看所需的医疗服务提供者。
