Department of Health Management and Policy (JK Pintor, CK Alberto, RM McKenna, and AN Ortega), Dornsife School of Public Health, Drexel University, Philadelphia, Penn.
Department of Family, Population & Preventive Medicine (HE Alcalá), Program in Public Health, Stony Brook Medicine, Stony Brook University, Stony Brook, NY.
Acad Pediatr. 2019 Apr;19(3):325-332. doi: 10.1016/j.acap.2018.09.003. Epub 2018 Sep 12.
To examine insurance-based disparities in provider-related barriers to care among children in California in the wake of changes to the insurance market resulting from the Affordable Care Act.
Our sample included 6514 children (ages 0 to 11 years) from the 2014-2016 California Health Interview Survey. We examined parent reports in the past year of 1) having trouble finding a general provider for the child, 2) the child not being accepted by a provider as a new patient, 3) the child's health insurance not being accepted by a provider, or 4) any of the above. Multivariable models estimated the associations of insurance type-Medi-Cal (Medicaid), employer-sponsored insurance, or privately purchased coverage-and parent reports of these problems.
Approximately 8% of parents had encountered at least one of these problems. Compared with parents of children with employer-sponsored insurance, parents of children with Medi-Cal or privately purchased coverage had over twice the odds of experiencing at least one of the barriers. Parents of children with Medi-Cal had over twice the odds of being told a provider would not accept their children's coverage or having trouble finding a general provider and 3times the odds of being told a provider would not accept their children as new patients. Parents of children with privately purchased coverage had over 3times the odds of being told a provider would not accept their children's coverage.
Our study found significant disparities in provider-related barriers by insurance type among children in California.
在平价医疗法案（Affordable Care Act）导致保险市场发生变化后，研究加利福尼亚州儿童在与提供者相关的护理障碍方面的保险差异。
我们的样本包括来自 2014-2016 年加利福尼亚健康访谈调查的 6514 名儿童（0 至 11 岁）。我们检查了父母在过去一年中报告的以下情况：1）为孩子找到普通医生有困难；2）孩子不被医生接受为新患者；3）孩子的医疗保险不被医生接受；或 4）以上任何一种情况。多变量模型估计了保险类型（医疗补助（Medicaid），雇主赞助保险或私人购买保险）与父母报告的这些问题之间的关联。
约有 8％的父母遇到了上述至少一个问题。与雇主赞助保险的儿童的父母相比，Medi-Cal 或私人购买保险的儿童的父母遇到至少一个障碍的可能性是其两倍以上。Medi-Cal 儿童的父母有超过两倍的可能性被告知提供者不会接受其子女的保险，或者难以找到普通医生，并且有 3 倍的可能性被通知提供者不会接受其子女为新患者。购买私人保险的儿童的父母有超过 3 倍的可能性被通知提供者不会接受其子女的保险。
我们的研究发现，加利福尼亚州儿童在与提供者相关的障碍方面存在显著的保险差异。
