Holl J L, Szilagyi P G, Rodewald L E, Byrd R S, Weitzman M L
Department of Pediatrics, University of Rochester (NY) School of Medicine and Dentistry, USA.
Arch Pediatr Adolesc Med. 1995 Apr;149(4):398-406. doi: 10.1001/archpedi.1995.02170160052008.
To describe the demographic characteristics, utilization of medical services, and health status of uninsured children compared with insured children in the United States and to assess the factors associated with lack of health insurance among children. An estimated 8 million children in the United States are uninsured. Medicaid expansions and tax credits have had little impact on the overall problem. An understanding of the characteristics of uninsured children is essential for the design of appropriate outreach and enrollment strategies, benefit packages, and health care provision arrangements for uninsured children.
Analysis of the 1988 Child Health Supplement of the National Health Interview Survey.
Diverse groups of children in the United States lack health insurance. Residence in the South (odds ratio [OR], 2.3) and West (OR, 1.9. [corrected]) and being poor (OR, 2.2) or nearly poor (OR, 2.1) are independently associated with being uninsured. Substantial differences in both sources of care and utilization of medical services exist between uninsured and insured children. Uninsured children lack usual sources of routine care (OR, 3.1) and sick care (OR, 3.8) and also lack appropriate well-child care (OR, 1.5) compared with insured children. Neither being in fair or poor health nor emergency department use are significant independent predictors of being uninsured among children. Children who have a chronic disease, such as asthma, face difficulties of access to care and utilize substantially fewer outpatient and inpatient services.
Universal health insurance, rather than efforts directed at specific groups, appears to be the only way to provide health insurance for all US children. Uninsured and insured children reveal marked discrepancies in access to and utilization of medical services, including preventive services, but have similar rates of chronic health conditions and limitations of activity. Uninsured children do not appear to form a population that will incur higher mean annual expenditures for medical care compared with insured children.
描述美国未参保儿童与参保儿童相比的人口统计学特征、医疗服务利用情况及健康状况，并评估与儿童未参保相关的因素。据估计，美国有800万儿童未参保。医疗补助计划的扩大和税收抵免对整体问题影响甚微。了解未参保儿童的特征对于设计针对未参保儿童的适当外展和参保策略、福利套餐及医疗服务提供安排至关重要。
对1988年全国健康访谈调查的儿童健康补充调查进行分析。
美国不同群体的儿童缺乏医疗保险。居住在南部（优势比[OR]，2.3）和西部（OR，1.9[校正后]）以及贫困（OR，2.2）或接近贫困（OR，2.1）与未参保独立相关。未参保儿童和参保儿童在医疗服务来源和利用方面存在显著差异。与参保儿童相比，未参保儿童缺乏常规护理（OR，3.1）和疾病护理（OR，3,8）的常规来源，也缺乏适当的儿童健康护理（OR，1.5）。健康状况一般或较差以及前往急诊科就诊均不是儿童未参保的显著独立预测因素。患有慢性疾病（如哮喘）的儿童在获得医疗服务方面面临困难，并且使用的门诊和住院服务要少得多。
全民医疗保险而非针对特定群体的努力似乎是为所有美国儿童提供医疗保险的唯一途径。未参保儿童和参保儿童在获得和利用包括预防服务在内的医疗服务方面存在明显差异，但慢性健康状况发生率和活动受限率相似。与参保儿童相比，未参保儿童似乎不会形成医疗费用年均支出更高的群体。
