Cunningham P J, Altman B M
Center for General Health Services Intramural Research, Agency for Health Care Policy and Research, Rockville, MD 20852.
Med Care. 1993 Jul;31(7):600-16. doi: 10.1097/00005650-199307000-00003.
Although most American Indians and Alaska Natives have access to health care through the Indian Health Service (IHS), it is uncertain whether IHS is able to provide all necessary health services to those with disabilities. Although IHS eligibles can use health services other than those provided or sponsored by IHS, this may be precluded by high rates of poverty, low rates of other health insurance coverage, and the lack of private providers in many areas inhabited by this population. Using data from the 1987 Survey of American Indians and Alaska Natives--the only nationally representative health care survey of persons eligible for IHS--this study examines the use of ambulatory health care for IHS eligibles with disabilities. Comparisons with the total US population showed similar rates of ambulatory care use for most categories of disability, but a higher frequency of use for the total US population. Findings also show that IHS provides most of the health care for its eligible population, although non-IHS care is also used. After controlling for the effects of sociodemographic characteristics and health insurance coverage, variables indicating disabilities due to health problems were found to have statistically significant effects on the likelihood of using non-IHS care. Furthermore, persons with activity limitations had a higher than average likelihood of using most of their health care at non-IHS providers. These findings suggest that for some persons with disabilities, it is necessary to supplement IHS care with services from other providers.
尽管大多数美国印第安人和阿拉斯加原住民可以通过印第安卫生服务局（IHS）获得医疗保健，但尚不确定IHS是否能够为残疾人士提供所有必要的医疗服务。虽然符合IHS资格的人可以使用IHS提供或资助之外的医疗服务，但高贫困率、低其他医疗保险覆盖率以及该人群居住的许多地区缺乏私人医疗服务提供者，可能会使这种情况无法实现。本研究利用1987年美国印第安人和阿拉斯加原住民调查的数据——这是唯一一项对符合IHS资格的人具有全国代表性的医疗保健调查——来考察符合IHS资格的残疾人士对门诊医疗保健的使用情况。与美国总人口的比较表明，大多数残疾类别在门诊医疗使用方面的比率相似，但美国总人口的使用频率更高。研究结果还表明，IHS为其符合资格的人群提供了大部分医疗保健服务，不过也有人使用非IHS的医疗服务。在控制了社会人口特征和医疗保险覆盖范围的影响后，发现表明因健康问题导致残疾的变量对使用非IHS医疗服务的可能性具有统计学上的显著影响。此外，有活动受限的人在非IHS医疗服务提供者处使用大部分医疗保健服务的可能性高于平均水平。这些发现表明，对于一些残疾人士来说，有必要用其他医疗服务提供者的服务来补充IHS的医疗服务。
