Newacheck P W, Pearl M, Hughes D C, Halfon N
Institute for Health Policy Studies, Department of Pediatrics, School of Medicine, University of California, San Francisco 94109, USA.
JAMA. 1998 Nov 25;280(20):1789-93. doi: 10.1001/jama.280.20.1789.
Congress enacted a series of laws beginning in the mid 1980s to expand Medicaid eligibility for children, especially those in poor families. As a result, Medicaid enrollment of children has nearly doubled over the past decade.
To assess the effectiveness of Medicaid in improving access to and use of health services by poor children.
Analysis of cross-sectional survey data from the 1995 National Health Interview Survey. Poor children with Medicaid were compared to poor children without insurance and nonpoor children with private insurance.
A total of 29711 children younger than 18 years (3716 poor children with Medicaid, 1329 poor children without insurance, 14609 nonpoor children with private insurance, and 10057 children with other combinations of poverty and insurance status) included in a nationally representative stratified probability sample of the US noninstitutionalized population.
Usual source of care, access to a regular clinician, unmet health needs, and use of physician services.
Poor children with Medicaid compared to poor children without health insurance experienced superior access across all measured dimensions of health care, including presence of a usual source of care (95.6% vs 73.8%), frequency of unmet health needs (2.1 % vs 5.9%), and use of medical services (eg, > or =1 physician contact in past year) (83.9% vs 60.7%). Poor children with Medicaid compared to nonpoor children with private insurance used similar levels of physician services (83.9% vs 84%), but were more likely to have unmet health needs (2.1 % vs 0.6%) and were less likely to have a usual source of care (95.6% vs 97.4%).
Medicaid is associated with improvements in access to care and use of services. However, there remains room for improvement when Medicaid is judged against private health insurance. The Balanced Budget Act of 1997 contains several Medicaid provisions that could stimulate further improvements in access for poor children.
国会自20世纪80年代中期开始颁布一系列法律，以扩大医疗补助计划对儿童的覆盖范围，尤其是贫困家庭的儿童。因此，在过去十年中，儿童的医疗补助计划参保人数几乎翻了一番。
评估医疗补助计划在改善贫困儿童获得和使用医疗服务方面的有效性。
对1995年全国健康访谈调查的横断面调查数据进行分析。将参加医疗补助计划的贫困儿童与未参保的贫困儿童以及参加私人保险的非贫困儿童进行比较。
共有29711名18岁以下儿童（3716名参加医疗补助计划的贫困儿童、1329名未参保的贫困儿童、14609名参加私人保险的非贫困儿童以及10057名具有其他贫困和保险状况组合的儿童）纳入美国非机构化人口的全国代表性分层概率样本。
通常的医疗服务来源、能否看固定的临床医生、未满足的医疗需求以及医生服务的使用情况。
与未参保的贫困儿童相比，参加医疗补助计划的贫困儿童在所有衡量的医疗保健维度上都有更好的就医机会，包括有通常的医疗服务来源（95.6%对73.8%）、未满足的医疗需求频率（2.1%对5.9%）以及医疗服务的使用情况（例如，过去一年中与医生接触≥1次）（83.9%对60.7%）。与参加私人保险的非贫困儿童相比，参加医疗补助计划的贫困儿童使用的医生服务水平相似（83.9%对84%），但更有可能有未满足的医疗需求（2.1%对0.6%），并且不太可能有通常的医疗服务来源（95.6%对97.4%）。
医疗补助计划与改善就医机会和服务使用情况相关。然而，与私人医疗保险相比，医疗补助计划仍有改进空间。1997年的《平衡预算法案》包含多项医疗补助计划条款，可能会促使贫困儿童的就医机会得到进一步改善。
