Children's health insurance status and emergency department utilization in the United States
Children's health insurance status and emergency department utilization in the United States
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DOI：
10.1542/peds.112.2.314
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发表时间：
2003-08-01
期刊：
影响因子：
8
通讯作者：
Hey, LA
中科院分区：
文献类型：
--
作者：
Luo, XM;Liu, G;Hey, LA
目标。急诊科人满为患已经成为一个全国性的问题。儿童占急症室就诊总数的近25%。据报道，未参保和公共参保的儿童可能会因紧急和非紧急问题而去ED就诊，但在控制其他混杂因素后，尚不清楚健康保险状况对儿童总体ED利用率或国家层面非紧急问题ED利用率的影响程度。本研究的目的是考察医疗保险状况对儿童总体ED利用率的影响，以及美国普通儿科人群中儿童对非紧急问题的ED利用率。对1997年对10193名18岁以下儿童进行的医疗支出小组调查中家庭部分的二次分析。主要观察指标为年总体ED利用率和非紧急问题的ED利用率。1997年，10.8%的儿童全年没有保险。全年共有17.5%的儿童参加了公共保险，而55.3%的儿童全年参加了私人保险。也有16.5%的儿童只在一年中的一段时间内投保。在没有调整协变量的情况下，公共保险的儿童在这一年中比私人保险的儿童(未调整的优势比[OR]：1.26；95%可信区间[CI]：1.03-1.55)和未保险的儿童(未调整的OR：1.46；95%的可信区间：1.1-1.95)更有可能去看ED。在控制协变量后，公共保险和私人保险儿童(调整OR：0.90；95%CI：0.70~1.16)和公共保险儿童和非保险儿童(调整OR：1.12；95%CI：0.84~1.49)之间的差异变得不显著。在对协变量进行调整或不调整的情况下，私人参保和未参保的儿童进行急诊室就诊的可能性没有显著差异。与整体急诊的利用模式相似，公共保险的儿童比私人保险(未调整的OR：1.86；95%CI：1.36~2.53)和未保险的儿童(未调整的OR：1.81；95%CI：1.15~2.84)更有可能进行非紧急的急诊。在控制协变量后，两种差异都消失了。在对协变量进行调整或不进行调整的情况下，私人保险和非保险儿童非紧急急诊室就诊的可能性没有显著差异。健康保险状况与儿童总体勃起功能障碍的使用或儿童在国家层面上对非紧急问题的勃起功能障碍的使用无关。我们的发现表明，试图缓解教育部门过度拥挤状况的政策努力应该寻找措施，而不仅仅是改变儿童的医疗保险覆盖范围。
Objectives. Emergency department (ED) overcrowding has become a national problem. Children account for nearly 25% of overall ED visits. It has been reported that uninsured and publicly insured children are likely to visit the ED for urgent and nonurgent problems, yet it remains unclear to what extent health insurance status would influence children's overall ED utilization or ED utilization for nonurgent problems at the national level after controlling for other confounding factors. The objective of this study was to examine the effect of health insurance status on children's overall ED utilization and children's ED utilization for nonurgent problems among the general pediatric population in the United States.Methods. Secondary analysis of the household component of the 1997 Medical Expenditure Panel Survey on 10 193 children younger than 18 years. The main outcome measures were annual overall ED utilization and ED utilization for nonurgent problems.Results. During 1997, 10.8% of children were uninsured for the entire year. A total of 17.5% of children were publicly insured the entire year, whereas 55.3% of children held private insurance the entire year. There were also 16.5% of children who were insured only part of the year. Without adjusting for covariates, publicly insured children were more likely to have an ED visit during the year than both privately insured children (unadjusted odds ratio [ OR]: 1.26; 95% confidence interval [ CI]: 1.03-1.55) and uninsured children (unadjusted OR: 1.46; 95% CI: 1.1-1.95). The difference between publicly insured and privately insured children (adjusted OR: 0.90; 95% CI: 0.70-1.16) and between publicly insured and uninsured children (adjusted OR: 1.12; 95% CI: 0.84-1.49) became insignificant after controlling for covariates. With or without adjustments for covariates, there was no significant difference in the likelihood of having an ED visit between privately insured and uninsured children. Similar to the utilization pattern of overall ED visits, publicly insured children were more likely to have a nonurgent ED visit than both privately insured (unadjusted OR: 1.86; 95% CI: 1.36-2.53) and uninsured children (unadjusted OR: 1.81; 95% CI: 1.15-2.84). Both differences disappeared after controlling for covariates. There was no significant difference in the likelihood of nonurgent ED visits between privately insured and uninsured children with or without adjustments for covariates.Conclusions. Health insurance status was not associated with children's overall ED use or children's ED use for nonurgent problems at the national level. Our findings suggest that policy efforts in an attempt to relieve ED overcrowding conditions should look for measures beyond solely making changes in health insurance coverage for children.