Vann J C, Biddle A K, Daeschner C W, Chaffee S, Gold S H
Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, USA.
Med Pediatr Oncol. 1995 Nov;25(5):389-95. doi: 10.1002/mpo.2950250505.
Historically, there has been evidence to support the hypothesis that survivors of childhood cancer have been discriminated against in the private health insurance market in some areas of the United States. Results of previous studies have been inconsistent and have generally focused on a limited number of outcome variables. A retrospective cohort study of young adult survivors of childhood cancer and their siblings was performed to determine the risk of health insurance access problems of childhood cancer survivors in North Carolina. Mailed questionnaires were completed by 182 cancer survivors from three institutions who were diagnosed between 1976 and 1988, and by 101 of their siblings for a response of 62.1%. Using logistic regression in SAS, cancer survivors were found to be more likely to be denied health insurance than their siblings, with an adjusted odds ratio of 15.1. Childhood cancer survivors also had health insurance policies that excluded care for pre-existing medical conditions more often than their siblings (OR = 5.5). In addition, cancer survivors reported problems obtaining health insurance coverage more frequently than their siblings with an adjusted odds ratio of 22.8. In general, survivors of childhood cancer who were diagnosed in North Carolina have had decreased access to health insurance coverage when compared to their siblings of similar age. North Carolina health insurance regulations permit health insurance firms to discriminate against cancer survivors because of their history of illness, often decreasing their access to needed follow-up care.
从历史上看，有证据支持这样一种假设，即美国某些地区的儿童癌症幸存者在私人健康保险市场中受到了歧视。先前研究的结果并不一致，且通常只关注有限数量的结果变量。为了确定北卡罗来纳州儿童癌症幸存者获得医疗保险的问题风险，对儿童癌症成年幸存者及其兄弟姐妹进行了一项回顾性队列研究。来自三个机构的182名在1976年至1988年间被诊断出患癌的幸存者及其101名兄弟姐妹通过邮寄问卷的方式完成了调查，回复率为62.1%。使用SAS中的逻辑回归分析发现，癌症幸存者比其兄弟姐妹更有可能被拒绝提供医疗保险，调整后的优势比为15.1。儿童癌症幸存者的健康保险政策排除对既往疾病护理的情况也比其兄弟姐妹更频繁（优势比 = 5.5）。此外，癌症幸存者报告获得医疗保险覆盖的问题比其兄弟姐妹更频繁，调整后的优势比为22.8。总体而言，与年龄相仿的兄弟姐妹相比，在北卡罗来纳州被诊断出患癌的儿童癌症幸存者获得医疗保险覆盖的机会有所减少。北卡罗来纳州的健康保险法规允许健康保险公司因癌症幸存者的疾病史而对其进行歧视，这往往减少了他们获得所需后续护理的机会。
