医疗保险覆盖范围对推荐临床预防服务合理使用的影响。
The effect of health insurance coverage on the appropriate use of recommended clinical preventive services.
作者信息
Faulkner L A, Schauffler H H
机构信息
School of Public Health, University of California, Berkeley 94720-7360, USA.
出版信息
Am J Prev Med. 1997 Nov-Dec;13(6):453-8.
INTRODUCTION
Lack of health insurance coverage has been shown to reduce use of some preventive services. However, even when care is free or fully covered by insurance, clinical preventive services are not used at recommended levels. This study investigates the impact of different levels of health insurance coverage (ranging from none, some, most, and all preventive services covered) on the use of recommended clinical preventive services for adult men and women.
METHODS
Logistic regression was used to estimate the effect of different levels of health insurance coverage for preventive care on the probability of receiving six different clinical preventive services including periodic health exam, blood pressure screening, cholesterol screening, Pap smear, clinical breast exam, and screening mammography, as well as all recommended services for a given age and gender group. The study sample of adults ages 18 to 64 is from the Centers for Disease Control's 1991 Behavioral Risk Factor Surveillance System (BRFSS) (n = 53,981).
RESULTS
The results demonstrate a positive and statistically significant dose-response relationship between level of health insurance coverage for preventive care and receipt of recommended preventive services in adult men and women. The odds ratios (ORs) of men who had full coverage for preventive care receiving recommended preventive services compared to men with no coverage for preventive care ranged from 1.8 to 2.8. For women the ORs were 1.2 to 2.0. The ORs for men with "most" preventive services covered compared to none covered ranged from 1.3 to 2.1, and for women from 1.2 to 2.0.
CONCLUSIONS
The level of health insurance coverage for preventive care is one of the most important determinants of receipt of recommended preventive services for adult men and women 18-64 years of age. These results suggest that comprehensive health insurance coverage for clinical preventive care may significantly increase receipt of recommended preventive services for this population.
引言
研究表明，缺乏医疗保险会减少某些预防性服务的使用。然而，即使医疗服务免费或完全由保险覆盖，临床预防性服务的使用也未达到推荐水平。本研究调查了不同水平的医疗保险覆盖范围（从无、部分、大部分到所有预防性服务覆盖）对成年男性和女性使用推荐临床预防性服务的影响。
方法
采用逻辑回归来估计不同水平的预防性医疗保健保险覆盖范围对接受六种不同临床预防性服务（包括定期健康检查、血压筛查、胆固醇筛查、巴氏涂片检查、临床乳房检查和乳房X线筛查）以及特定年龄和性别组所有推荐服务的概率的影响。18至64岁成年人的研究样本来自疾病控制中心1991年的行为危险因素监测系统（BRFSS）（n = 53,981）。
结果
结果表明，成年男性和女性预防性医疗保健保险覆盖水平与接受推荐预防性服务之间存在正向且具有统计学意义的剂量反应关系。与没有预防性医疗保健保险覆盖的男性相比，拥有全面预防性医疗保健保险覆盖的男性接受推荐预防性服务的优势比（OR）在1.8至2.8之间。对于女性，OR为1.2至2.0。与没有覆盖任何预防性服务的男性相比，“大部分”预防性服务有覆盖的男性的OR在1.3至2.1之间，女性的OR在1.2至2.0之间。
结论
预防性医疗保健保险覆盖水平是18至64岁成年男性和女性接受推荐预防性服务的最重要决定因素之一。这些结果表明，临床预防性医疗保健的全面医疗保险覆盖可能会显著增加该人群接受推荐预防性服务的比例。
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