Call K T, Lurie N, Jonk Y, Feldman R, Finch M D
Institute for Health Services Research, School of Public Health, University of Minnesota, Minneapolis 55455, USA.
JAMA. 1997 Oct 8;278(14):1191-5.
To describe Minnesota's health care system reform efforts and their implications for other state and national reform initiatives, document the rate of uninsurance in 1990 and 1995 with special attention to childrens' access to health insurance, and examine the effectiveness of MinnesotaCare, a voluntary state-subsidized health care plan, in serving its target population.
Three cross-sectional telephone surveys: 2-stage random samples of Minnesotans of all ages in 1990 and 1995 and a stratified random sample of MinnesotaCare enrollees in 1994.
For the 2 statewide surveys, 10310 respondents participated in 1990 and 11519 in 1995; more detailed information was collected on approximately 1600 respondents in each survey. Eight hundred MinnesotaCare enrollees participated in the third survey conducted in 1994.
Changes in rates of uninsurance.
While the rate of uninsurance increased at the national level, the point-in-time Minnesota rate remained stable and low at 6% between 1990 and 1995. The proportion of children uninsured for 12 months or more decreased from 5.2% in 1990 to 3.1% in 1995, while the proportion of uninsured single adults remained stable at approximately 11%. There was no evidence that MinnesotaCare enrollees are gaming the program, or that the program has resulted in significant erosion from the private market.
MinnesotaCare has enabled the state to maintain a low rate of uninsurance and has reduced this rate among its primary target: children. The program has been less effective in enrolling single adults, although it may be too early to witness the effects of recent expansions targeting this group. Minnesota's experience suggests that other state and national reform efforts aimed at reducing uninsurance, particularly among children, are likely to be successful.
描述明尼苏达州的医疗保健系统改革举措及其对其他州和全国改革倡议的影响，记录1990年和1995年的未参保率，特别关注儿童获得医疗保险的情况，并考察明尼苏达保健计划（一项由州政府补贴的自愿性医疗保健计划）在服务其目标人群方面的成效。
三项横断面电话调查：1990年和1995年对明尼苏达州所有年龄段居民进行两阶段随机抽样，以及1994年对明尼苏达保健计划参保者进行分层随机抽样。
在两项全州范围的调查中，1990年有10310名受访者参与，1995年有11519名；每次调查中约1600名受访者被收集了更详细的信息。800名明尼苏达保健计划参保者参与了1994年进行的第三次调查。
未参保率的变化。
虽然全国范围内未参保率有所上升，但1990年至1995年间，明尼苏达州的即时未参保率保持稳定且较低，为6%。未参保12个月及以上的儿童比例从1990年的5.2%降至1995年的3.1%，而未参保单身成年人的比例则稳定在约11%。没有证据表明明尼苏达保健计划的参保者在利用该计划，也没有证据表明该计划导致了私人市场的显著流失。
明尼苏达保健计划使该州能够维持较低的未参保率，并降低了其主要目标人群（儿童）中的未参保率。该计划在招募单身成年人方面效果较差，不过观察针对这一群体的近期扩大覆盖范围的效果可能还为时过早。明尼苏达州的经验表明，其他旨在降低未参保率，尤其是儿童未参保率的州和全国性改革举措可能会取得成功。
