Is insurance a more important determinant of healthcare access than perceived health? Evidence from the women's health initiative
Is insurance a more important determinant of healthcare access than perceived health? Evidence from the women's health initiative
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DOI：
10.1089/152460900750020919
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发表时间：
2000-10-01
期刊：
影响因子：
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通讯作者：
Limacher, M
中科院分区：
文献类型：
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作者：
Hsia, J;Kemper, E;Limacher, M
我们的目标是探讨健康保险的地位和保险类型，自我报告和感知的健康变量进行调整，在妇女的健康倡议（WHI）观察性研究（OS）的决定因素，有和使用一个常用的护理提供者。这项分析描述了一个大的，不同的老年妇女群体的保险状况和测试的假设，保险是一个关键的预测，他们获得医疗保健在20世纪90年代中期。采用多因素logistic回归分析，使用55，278名绝经后妇女的人群队列提供的横断面信息，评估在12个月内访问常规医疗保健提供者的决定因素。OS队列中5%的65岁以下女性和0.2%的65岁或以上女性缺乏健康保险。在31，684名年龄在50-64岁之间的女性中，西班牙裔女性和那些受教育年限较短，家庭收入较低以及目前吸烟者的可能性较小，而那些缺乏保险的人最不可能在前一年内看到他们的医疗保健提供者。在23，594名年龄在65-79岁之间的女性中，非洲裔美国人和西班牙裔女性以及家庭收入较低的女性，仅医疗保险和目前吸烟者，在前一年内不太可能看到他们的医疗保健提供者。在这两个年龄组中，患有慢性疾病和感知健康评分较差的女性以及预付保险的女性更有可能看到他们的医疗保健提供者。在WHI OS中，健康（自我报告和感知）和健康保险类型在对彼此以及相关社会人口特征进行多变量调整后，与访问普通医疗保健提供者独立相关。
Our objectives were to explore health insurance status and insurance type, adjusted for self-reported and perceived health variables, as determinants of having and using a usual care provider in the Women's Health Initiative (WHI) Observational Study (OS). This analysis describes insurance status in a large, diverse group of older women and tests the hypothesis that insurance was a key predictor of their access to healthcare in the mid-1990s. Multiple logistic regression analysis was used to evaluate determinants of having visited a usual healthcare provider within the proceeding 12 months, using cross-sectional information provided by a population-based cohort of 55,278 postmenopausal women. Five percent of women younger than 65 years and 0.2% of women 65 or older in the OS cohort lacked health insurance. Among the 31,684 women, aged 50-64 years, Hispanic women and those with fewer years of education and lower household income and who were current smokers were less likely, and those lacking insurance were the least likely, to have seen their healthcare provider within the preceding year. Among 23,594 women, aged 65-79 years, African American and Hispanic women and those with lower household income, and Medicare only and those who were current smokers, were less likely to have seen their healthcare provider within the preceding year. In both age groups, women with chronic medical conditions and poorer perceived health scores and those with prepaid insurance were more likely to have seen their healthcare provider. In the WHI OS, both health (self-reported and perceived) and type of health insurance remained independently associated with having visited a usual healthcare provider after multivariate adjustment for one another as well as for pertinent sociodemographic characteristics.