Alina S. Schnake-Mahl (
Benjamin D. Sommers is an associate professor of health policy and economics in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, and an associate professor of medicine at Brigham and Women's Hospital, both in Boston, Massachusetts.
Health Aff (Millwood). 2017 Oct 1;36(10):1777-1785. doi: 10.1377/hlthaff.2017.0545.
There are 16.9 million Americans living in poverty in the suburbs-more than in cities or rural communities. Despite recent increases in suburban poverty, the perception of the suburbs as areas of uniform affluence remains, and there has been little research into health care barriers experienced by people living in these areas. The objectives of this study were to compare patterns of insurance coverage and health care access in suburban, urban, and rural areas using national survey data from 2005 to 2015 and to compare outcomes by geography before and after the Affordable Care Act took effect. We found that nearly 40 percent of the uninsured population lived in suburban areas. Though unadjusted rates of health care access were better in suburban areas, compared to urban and rural communities, this advantage was greatly reduced after income and other demographics are accounted for. Overall, a substantial portion of the US population residing in the suburbs lacked health insurance and experienced difficulties accessing care. Increased policy attention is needed to address these challenges for vulnerable populations living in the suburbs.
美国有 1690 万生活在贫困中的居民生活在郊区——比城市或农村地区都多。尽管最近郊区的贫困率有所上升,但人们对郊区作为一个统一富裕地区的看法仍然存在,而且对于生活在这些地区的人所经历的医疗保健障碍的研究很少。本研究的目的是使用 2005 年至 2015 年的全国调查数据,比较郊区、城市和农村地区的保险覆盖范围和医疗保健获取模式,并在平价医疗法案生效前后比较不同地区的结果。我们发现,近 40%的无保险人口居住在郊区。尽管与城市和农村社区相比,郊区的医疗保健获取率未经调整的比例更高,但在考虑了收入和其他人口统计学因素后,这一优势大大降低。总体而言,相当一部分居住在郊区的美国人口缺乏医疗保险,并且在获得医疗服务方面存在困难。需要增加政策关注,以解决生活在郊区的弱势群体面临的这些挑战。