Wu Liyun, Wang Gang, Birore Charles M S
a The Ethelyn R. Strong School of Social Work , Norfolk State University , Norfolk , VA.
b Department of Political Science , University of Zürich , Zürich , Switzerland.
Soc Work Public Health. 2018;33(7-8):497-509. doi: 10.1080/19371918.2018.1546253. Epub 2018 Nov 30.
This study aims to examine the health care hardships among veterans and the effects from the measures of disability statuses and health insurance coverage. Patterns and variations for different subgroups are categorized and analyzed. Using the 2014 National Health Interview Survey (NHIS), this study included 2,686 veterans who were active duty in U.S. military in Persian Gulf War in the 1990s and Gulf War-era II since September 2001 or later. The dependent variable, medical hardship, was measured with four dichotomous indicators: problems paying medical bills, currently having medical bills that were being paid over time, currently having medical bills that were unable to be paid at all, and having medical care delayed due to cost. The independent variables were disability status and health care coverage. Covariates included demographics (age, gender, race), socioeconomic status (education, poverty status), along with marital status and self-reported health status. Logistic regressions were employed to predict the likelihood of experiencing health care hardships. Statistical results indicated that health disparities were prevalent in terms of health care hardships. Disabled veterans were more likely to report medical hardships compared to their counterparts with no disability. Having no health insurance coverage further deteriorated the severity of medical hardship. Veterans who self-reported poor health lived in poverty were less educated, and had higher likelihood of experiencing health care hardship. The policy implications can be lined with disabled veterans' programs in terms of outreach activities, community services, and integrated care.
本研究旨在调查退伍军人的医疗保健困难情况以及残疾状况和医疗保险覆盖措施所产生的影响。对不同亚组的模式和差异进行分类和分析。本研究使用2014年全国健康访谈调查（NHIS），纳入了2686名退伍军人，他们在20世纪90年代的海湾战争以及2001年9月或之后的第二次海湾战争时期在美国军队服现役。因变量“医疗困难”通过四个二分指标来衡量：支付医疗账单有问题、目前有医疗账单正在分期支付、目前有医疗账单根本无法支付以及因费用问题导致医疗延误。自变量为残疾状况和医疗保健覆盖情况。协变量包括人口统计学特征（年龄、性别、种族）、社会经济地位（教育程度、贫困状况），以及婚姻状况和自我报告的健康状况。采用逻辑回归来预测经历医疗保健困难的可能性。统计结果表明，在医疗保健困难方面普遍存在健康差异。与无残疾的退伍军人相比，残疾退伍军人更有可能报告医疗困难。没有医疗保险覆盖进一步加剧了医疗困难的严重程度。自我报告健康状况不佳、生活贫困且受教育程度较低的退伍军人经历医疗保健困难的可能性更高。在宣传活动、社区服务和综合护理方面，政策影响可与残疾退伍军人项目挂钩。
