Butler J A, Singer J D, Palfrey J S, Walker D K
Pediatrics. 1987 Jan;79(1):89-98.
The effect of insurance coverage on physician use for children in the United States who have been identified as disabled by their schools under the provisions of the Education for All Handicapped Children Act (PL 94-142) is examined. The research is based on identically drawn stratified random samples of children from the elementary school special education populations of five large metropolitan school systems. It was found that health insurance coverage was a predictor of whether a disabled child had seen a doctor in the past year even after adjustment for site, family background characteristics, type and severity of childhood disability, and structural access factors (adjusted odds ratio, 1.76, P less than .05); Hispanic children with disabilities were more likely than white children to be without any health insurance (adjusted odds ratio, 3.63; P less than .001), but there was no similar statistically significant difference between blacks and whites; and wide variations persist in scope of insurance payment for care, such that parents of publicly insured children paid out of pocket for only 5% of all physician visits as compared to 30% of visits for the privately insured. Even for children with various low-prevalence disabilities, when privately insured, parents paid out of pocket for 23% of all physician visits. These data help clarify the extent of health insurance coverage among children with disabilities and indicate that insurance remains an important predictor of physician use even though it continues to pay for only certain elements of care.
本文考察了保险覆盖范围对美国那些根据《所有残疾儿童教育法》（公法94 - 142）被学校认定为残疾的儿童就医情况的影响。该研究基于从五个大型都市学校系统的小学特殊教育群体中抽取的相同分层随机样本。研究发现，即使在对地点、家庭背景特征、儿童残疾类型和严重程度以及结构可及性因素进行调整之后，健康保险覆盖范围仍是残疾儿童在过去一年是否看过医生的一个预测指标（调整后的优势比为1.76，P值小于0.05）；残疾西班牙裔儿童比白人儿童更有可能没有任何健康保险（调整后的优势比为3.63；P值小于0.001），但黑人和白人之间没有类似的统计学显著差异；而且保险支付护理费用的范围存在很大差异，例如，参加公共保险儿童的父母在所有看医生费用中自掏腰包的比例仅为5%，而参加私人保险儿童的这一比例为30%。即使对于患有各种低发性残疾的儿童，参加私人保险时，父母在所有看医生费用中自掏腰包的比例也为23%。这些数据有助于厘清残疾儿童的健康保险覆盖范围，并表明保险仍然是就医情况的一个重要预测指标，尽管它仍只为某些护理项目付费。
