The University of Texas at Austin Steve Hicks School of Social Work, Austin, TX 78712, USA.
Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, RI 02903, USA.
Int J Environ Res Public Health. 2020 Apr 15;17(8):2711. doi: 10.3390/ijerph17082711.
Lack of health insurance (HI) is a particular problem for near-older Americans aged 50-64 because they tend to have more chronic health conditions than younger age groups and are at increased risk of disability; however, little recent research has focused on HI coverage and healthcare access among this age group. Using the U.S. National Health Interview Survey data for the years 2013 to 2018, we compared HI coverage and healthcare access between the 50-64 and 65+ age groups. Using logistic regression analysis, we then examined the sociodemographic and health characteristics of past-year healthcare access of near-older Americans without HI to those with private HI or public HI (Medicare without Medicaid, Medicaid without Medicare, Medicare and Medicaid, and VA/military HI). We estimated the odds of healthcare access among those without HI compared to those with private or public HI. Near-older Americans without HI were at least seven times more likely to have postponed or foregone needed healthcare due to costs, and only 15% to 23% as likely to have had contact with any healthcare professional in the preceding 12 months. Expanding HI to near-older adults would increase healthcare access and likely result in reduced morbidity and mortality and higher quality of life for them.
缺乏健康保险（HI）是 50-64 岁的临近老年人面临的一个特殊问题，因为他们往往比年轻群体有更多的慢性健康问题，并且残疾风险增加；然而，最近很少有研究关注这个年龄段的 HI 覆盖范围和医疗保健获取情况。利用美国国家健康访谈调查 2013 年至 2018 年的数据，我们比较了 50-64 岁和 65 岁以上年龄组的 HI 覆盖范围和医疗保健获取情况。然后，我们使用逻辑回归分析，研究了没有 HI 的临近老年人过去一年的医疗保健获取情况的社会人口统计学和健康特征，这些人有无私人 HI 或公共 HI（没有医疗补助的医疗保险、没有医疗保险的医疗补助、医疗保险和医疗补助、VA/军队 HI）。我们估计了没有 HI 的人获得医疗保健的可能性与有私人或公共 HI 的人相比。没有 HI 的临近老年人由于费用而推迟或放弃所需医疗保健的可能性至少高出七倍，而在过去 12 个月内与任何医疗保健专业人员接触的可能性仅为 15%至 23%。扩大 HI 覆盖范围将增加医疗保健的获取机会，并可能降低他们的发病率和死亡率，提高他们的生活质量。
