Assuring Adequate Health Insurance for Children With Special Health Care Needs: Progress From 2001 to 2009-2010
Assuring Adequate Health Insurance for Children With Special Health Care Needs: Progress From 2001 to 2009-2010
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DOI：
10.1016/j.acap.2015.02.002
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发表时间：
2015-07-01
影响因子：
3.1
通讯作者：
Bachman, Sara S.
中科院分区：
文献类型：
--
作者：
Ghandour, Reem M.;Comeau, Meg;Bachman, Sara S.
目的：报告2009-2010年有特殊医疗需求儿童(CSHCN)的医疗保险覆盖率和充分性，并评估自2001年以来的变化。方法：数据来自全国有特殊医疗需要儿童调查(NS-CSHCN)，随机数字电话调查，有40 243人(2009-2010)和38,866人(2001)完成访谈。保险的一致性和充分性的衡量标准是：1)保险覆盖状况，2)保险覆盖差距，3)所需服务的覆盖范围，4)未覆盖成本的合理性，以及5)父母所报告的看到所需提供者的能力。进行了双变量和多变量分析，以评估2009-2010年与适当保险覆盖相关的因素。结果：在2001-2009年间，拥有私人保险的CSHCN比例从64.7%下降到50.7%，而公共覆盖比例从21.7%上升到34.7%；没有任何保险的CSHCN比例从5.2%下降到3.5%。有足够保险的CSHCN的比例随时间和保险类型的不同而不同：在私人承保的CSHCN中，有足够保险的比例下降(62.6%至59.6%)，而在公共承保的CSHCN中，有足够保险的比例增加(63.0%至70.7%)。公共参保的CSHCN在3个充分性组成部分中的每一个都经历了改善。结论：从私人保险向公共保险的持续转变，更负担得起，提供的福利更有可能满足CSHCN的需求，并允许CSHCN看到必要的提供者。
OBJECTIVE: To report on coverage and adequacy of health insurance for children with special health care needs (CSHCN) in 2009-2010 and assess changes since 2001.METHODS: Data were from the National Survey of Children with Special Health Care Needs (NS-CSHCN), a random-digit telephone survey with 40,243 (2009-2010) and 38,866 (2001) completed interviews. Consistency and adequacy of insurance was measured by: 1) coverage status, 2) gaps in coverage, 3) coverage of needed services, 4) reasonableness of uncovered costs, and 5) ability to see needed providers, as reported by parents. Bivariate and multivariable analyses were conducted to assess factors associated with adequate insurance coverage in 2009-2010. Unadjusted and adjusted prevalence estimates were examined to identify changes in the type of insurance coverage and the proportion of CSHCN with adequate coverage by insurance type.RESULTS: The proportion of CSHCN with private coverage decreased from 64.7% to 50.7% between 2001 and 2009 2010, while public coverage increased from 21.7% to 34.7%; the proportion of CSHCN without any insurance declined from 5.2% to 3.5%. The proportion of CSHCN with adequate coverage varied over time and by insurance type: among privately covered CSHCN, the proportion with adequate coverage declined (62.6% to 59.6%), while among publicly covered CSHCN, the proportion with adequate insurance increased (63.0% to 70.7%). Publicly insured CSHCN experienced improvements in each of the 3 adequacy components.CONCLUSIONS: There has been a continued shift from private to public coverage, which is more affordable, offers benefits that are more likely to meet CSHCN needs, and allowed CSHCN to see necessary providers.