Hagdrup N A, Simoes E J, Brownson R C
Saint Louis University Health Sciences Center, Department of Community and Family Medicine, MO 63104, USA.
J Community Health. 1997 Oct;22(5):387-99. doi: 10.1023/a:1025131721791.
Physician counseling of patients on health related activities is an essential component of chronic disease prevention, however this requires patients to have ready access to health care providers. Previous studies have explored access to health care in terms of health plans and cost without accounting for the lack of preventive coverage inherent in many insurance policies. This study compares two measures of health care access, one using an assessment of cost and health plan availability, and a new coverage measure including preventive services. Data was collected from 2574 adult respondents to the 1991-92 Missouri Behavioral Risk Factor Surveillance System Surveys. Odds ratios were generated for demographic variables, health related behaviors and preventive screening and the two coverage measures. Using health plan and cost 22% lacked full coverage, however including availability of preventive coverage almost 60% lacked full coverage for preventive care. For both coverage measures significant associations were found with age, exercise, marital status, routine checkup and mammography screening. Using the measure of coverage of preventive services, rural residents and those who had never had cholesterol screening were more likely to lack coverage. Inclusion of preventive care in measures of health care coverage may alter previously reported associations with socio-demographic and health related factors. Policy makers should realize that including preventive services in health care coverage greatly increases the number of individuals lacking adequate coverage, and that those lacking adequate coverage are the least likely to undergo preventive screening.
医生就与健康相关的活动向患者提供咨询是慢性病预防的重要组成部分，然而这要求患者能够方便地接触到医疗服务提供者。以往的研究探讨了在健康计划和成本方面获得医疗服务的情况，但没有考虑到许多保险政策中固有的预防性保险缺失问题。本研究比较了两种衡量医疗服务可及性的方法，一种使用成本和健康计划可获得性评估，另一种是包括预防服务的新保险覆盖衡量方法。数据收集自1991 - 1992年密苏里行为风险因素监测系统调查的2574名成年受访者。针对人口统计学变量、与健康相关的行为以及预防性筛查和两种保险覆盖衡量方法生成了优势比。使用健康计划和成本衡量时，22%的人缺乏全面保险，然而将预防性保险的可获得性纳入考量后，近60%的人缺乏预防性护理的全面保险。对于这两种保险覆盖衡量方法，均发现与年龄、运动、婚姻状况、定期体检和乳房X光筛查存在显著关联。使用预防性服务的保险覆盖衡量方法时，农村居民和从未进行过胆固醇筛查的人更有可能缺乏保险覆盖。在医疗服务覆盖衡量方法中纳入预防性护理可能会改变先前报告的与社会人口统计学和健康相关因素的关联。政策制定者应认识到，在医疗服务覆盖中纳入预防性服务会大大增加缺乏足够保险覆盖的人数，而且那些缺乏足够保险覆盖的人最不可能接受预防性筛查。
