Annual Report on Health Care for Children and Youth in the United States: Trends in Racial/Ethnic, Income, and Insurance Disparities Over Time, 2002-2009
Annual Report on Health Care for Children and Youth in the United States: Trends in Racial/Ethnic, Income, and Insurance Disparities Over Time, 2002-2009
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DOI：
10.1016/j.acap.2013.02.003
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发表时间：
2013-05-01
影响因子：
3.1
通讯作者：
Simpson, Lisa
中科院分区：
文献类型：
--
作者：
Berdahl, Terceira A.;Friedman, Bernard S.;Simpson, Lisa
目的：研究儿童健康获取、利用和支出的长期趋势（2002 - 2009年）按种族/民族、收入和保险状况/预期付款人分类。数据包括2002 - 2009年美国医疗支出小组调查（MEPS）中具有全国代表性的儿童随机样本和全国范围内的儿科住院样本在2005年和2009年从医疗保健成本和利用项目（HCUP）.结果：儿童的比例与私人保险覆盖率从2002年的65.3%下降到2009年的60.6%。与此同时，公共保险儿童的比例从2002年的27.0%增加到2009年的33.1%。与2002年（7.7%）相比，2009年（6.3%）报告没有保险的儿童较少。最显著的进步是西班牙裔儿童，其未投保的比例从2002年的15.0%下降到2009年的10.3%。没有保险的人始终是最不可能获得通常护理的人，这种差异在2009年保持不变。在2002年和2009年，非西班牙裔白人最有可能报告通常的护理来源。白人和西班牙裔儿童去看医生的比例有所提高（2009年与2002年相比）。相比之下，黑人儿童在这段时间内没有得到改善。2002年至2009年期间，儿童的平均医疗保健总支出从1 294美元增加到1 914美元。从2002年到2009年，白色儿童参加私人医疗保险的平均总支出几乎翻了一番。在婴儿中，因肺炎住院的绝对数量（41，000至34，000）和出院比例（0.8%至0.7%）下降。液体和电解质紊乱也随着时间的推移而减少。流感仅在2009年出现在前15名诊断名单中，有11，000例住院病例。对于1至17岁的儿童，哮喘住院的绝对数量（从119，000增加到134，000）和出院比例（6.6%到7.6%）增加。皮肤感染出现在前15类在2009年，57,000例（3.3%的总数）。结论：尽管在保险覆盖率显着改善，种族/民族和收入的差距持续在获得和使用的护理。西班牙裔儿童在许多方面都取得了进步，而黑人儿童则没有。由于种族/民族和社会经济差异经常被报告为单一的横断面研究，我们的方法是创新的，并通过检查2002 - 2009年期间的人口趋势，改进了以前的研究。我们的研究揭示了在最近的经济危机中儿童的差异。
OBJECTIVE: To examine trends in children's health access, utilization, and expenditures over time (2002-2009) by race/ethnicity, income, and insurance status/expected payer.METHODS: Data include a nationally representative random sample of children in the United States in 2002-2009 from the Medical Expenditure Panel Survey (MEPS) and a nationwide sample of pediatric hospitalizations in 2005 and 2009 from the Healthcare Cost and Utilization Project (HCUP).RESULTS: The percentage of children with private insurance coverage declined from 65.3% in 2002 to 60.6% in 2009. At the same time, the percentage of publicly insured children increased from 27.0% in 2002 to 33.1% in 2009. Fewer children reported being uninsured in 2009 (6.3%) compared to 2002 (7.7%). The most significant progress was for Hispanic children, for whom the percentage of uninsured dropped from 15.0% in 2002 to 10.3% in 2009. The uninsured were consistently the least likely to have access to a usual source of care, and this disparity remained unchanged in 2009. Non-Hispanic whites were most likely to report a usual source of care in both 2002 and 2009. The percentage of children with a doctor visit improved for whites and Hispanics (2009 vs 2002). In contrast, black children saw no improvement during this time period. Between 2002 and 2009, children's average total health care expenditures increased from $1294 to $1914. Average total expenditures nearly doubled between 2002 and 2009 for white children with private health insurance. Among infants, hospitalizations for pneumonia decreased in absolute number (41,000 to 34,000) and as a share of discharges (0.8% to 0.7%). Fluid and electrolyte disorders also decreased over time. Influenza appeared only in 2009 in the list of top 15 diagnoses with 11,000 hospitalization cases. For children aged 1 to 17, asthma hospitalization increased in absolute number (from 119,000 to 134,000) and share of discharges (6.6% to 7.6%). Skin infections appeared in the top 15 categories in 2009, with 57,000 cases (3.3% of total).CONCLUSIONS: Despite significant improvement in insurance coverage, disparities by race/ethnicity and income persist in access to and use of care. Hispanic children experienced progress in a number of measures, while black children did not. Because racial/ethnic and socioeconomic disparities are often reported as single cross-sectional studies, our approach is innovative and improves on prior studies by examining population trends during the time period 2002-2009. Our study sheds light on children's disparities during the most recent economic crisis.