Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021.
Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021.
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DOI：
10.1001/jamahealthforum.2023.4179
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发表时间：
2023-11-03
期刊：
影响因子：
--
通讯作者：
Admon, Lindsay K.
中科院分区：
文献类型：
--
作者：
Daw, Jamie R.;Yekta, Sarra;Jacobson-Davies, Faelan E.;Patrick, Stephen W.;Admon, Lindsay K.
在美国，与公共保险和商业保险的儿童相比，与不充分和不一致的医疗保险覆盖范围相关的费率、儿童和家庭特征如何？这项对203名 691儿童的横断面研究发现，公共保险的儿童经历了更高的不一致覆盖率，而商业保险的儿童面临更高的覆盖率不足。新冠肺炎突发公共卫生事件期间，公共保险一致性和商业保险充足率大幅提升。这项横断面研究的结果表明，需要制定政策来解决每一类参保儿童所面临的独特问题，以提高在延期情况下儿童健康保险的一致性和质量。在新冠肺炎突发公共卫生事件之前和期间，商业保险和公共保险的儿童在获得一致和足够的医疗保险方面可能面临不同的挑战。以比较总体费率、新冠肺炎PHE相关变化以及与公共和商业保险儿童保险不一致和不充分相关的儿童和家庭特征。这是一项横断面研究，使用了2016至2021年全国儿童健康调查中具有全国代表性的数据，调查对象为生活在非机构环境中的0至17岁儿童。父母或照顾者报告的当前儿童健康保险类型，定义为公共或商业。不一致的保险，定义为在过去一年中有保险缺口；保险不足，定义为未能满足3个标准：(1)福利通常/总是足以满足儿童的需要；(2)保险通常/总是允许儿童获得所需的保健从业者；(3)没有或通常/总是合理的儿童保健年度自付费用。使用调查加权Logistic回归来比较保险类型、年份(2020-2021年与2016-2019年)以及保险类型中的儿童特征的结果。在具有全国代表性的203名 691名参保儿童样本中，34.5%参加了公共保险(平均[SD]年龄，8.4[4.1]岁；47.4%为女性)，65.5%参加了商业保险(平均[SD]年龄，8.7[5.6]岁；49.1%女性)。大多数公共保险儿童要么是非西班牙裔黑人(20.9%)，要么是西班牙裔(36.4%)；与已婚父母(38.4%)或单亲父母(33.1%)生活在一起；家庭收入低于联邦贫困水平的200%(79%)。大多数商业保险的儿童是非西班牙裔白人(62.8%)，与已婚父母住在一起(79.0%)；家庭收入达到或超过联邦贫困水平的400%(49.1%)。与商业保险儿童相比，公共保险儿童的不一致覆盖率更高(4.2%比1.4%；差异，2.7个百分点；95%CI，2.3到3.2)，而不充分覆盖率更低(12.2%比33.0%；差异，−20.8 pp；95%CI，−21.6to−20.0)。与2016年至2019年期间相比，新冠肺炎PHE期间(2020-2021年)，公共参保儿童的不一致保险减少了42%，商业保险儿童的保险不足减少了6%。与不充分和不一致的保险有关的儿童和家庭特征因保险类型而异。这项横断面研究的结果表明，保险缺口对于公共保险的儿童来说是一个特别的问题，而保险不足，特别是自掏腰包的费用对商业保险的儿童来说是一个挑战。这两个挑战在新冠肺炎PHE期间都有所改善。在《公共卫生政策》之后，提高儿童的健康覆盖率将需要针对商业和公共保险儿童的独特需求的政策解决方案。这项针对美国商业和公共保险儿童的横断面研究，评估了新冠肺炎突发公共卫生事件之前和期间的医疗覆盖差距、充分性和可负担性。
How do the rates and child and family characteristics associated with inadequate and inconsistent health insurance coverage compare for publicly vs commercially insured children in the US? This cross-sectional study of 203 691 children found that publicly insured children experienced higher rates of inconsistent coverage, whereas commercially insured children faced higher rates of inadequate coverage. Public insurance consistency and commercial insurance adequacy improved substantially during the COVID-19 public health emergency. The findings of this cross-sectional study suggest that policies are needed to address the unique issues faced by each population of insured children to improve the consistency and quality of children’s health coverage in the postpandemic context. Before and during the COVID-19 public health emergency (PHE), commercially and publicly insured children may have faced different challenges in obtaining consistent and adequate health insurance. To compare overall rates, COVID-19 PHE-related changes, and child and family characteristics associated with inconsistent and inadequate coverage for publicly and commercially insured children. This was a cross-sectional study using nationally representative data from the 2016 to 2021 National Survey of Children’s Health of children from age 0 to 17 years living in noninstitutional settings. Parent- or caregiver-reported current child health insurance type defined as public or commercial. Inconsistent insurance, defined as having an insurance gap in the past year; and inadequate insurance, defined by failure to meet 3 criteria: (1) benefits usually/always sufficient to meet child’s needs; (2) coverage usually/always allows child to access needed health care practitioners; and (3) no or usually/always reasonable annual out-of-pocket payments for child’s health care. Survey-weighted logistic regression was used to compare outcomes by insurance type, by year (2020-2021 vs 2016-2019), and by child characteristics within insurance type. Of this nationally representative sample of 203 691 insured children, 34.5% were publicly insured (mean [SD] age, 8.4 [4.1] years; 47.4% female) and 65.5% were commercially insured (mean [SD] age, 8.7 [5.6]; 49.1% female). Most publicly insured children were either non-Hispanic Black (20.9%) or Hispanic (36.4%); living with 2 married parents (38.4%) or a single parent (33.1%); and had a household income less than 200% of the federal poverty level (79%). Most commercially insured children were non-Hispanic White (62.8%), living with 2 married parents (79.0%); and had a household income of 400% of the federal poverty level or higher (49.1%). Compared with commercially insured children, publicly insured children had higher rates of inconsistent coverage (4.2% vs 1.4%; difference, 2.7 percentage points [pp]; 95% CI, 2.3 to 3.2) and lower rates of inadequate coverage (12.2% vs 33.0%; difference, −20.8 pp; 95% CI, −21.6 to −20.0). Compared with the period from 2016 to 2019, inconsistent insurance decreased by 42% for publicly insured children and inadequate insurance decreased by 6% for commercially insured children during the COVID-19 PHE (2020-2021). The child and family characteristics associated with inadequate and inconsistent insurance varied by insurance type. The findings of this cross-sectional study indicate that insurance gaps are a particular problem for publicly insured children, whereas insurance inadequacy and particularly, out-of-pocket costs are a challenge for commercially insured children. Both challenges improved during the COVID-19 PHE. Improving children’s health coverage after the PHE will require policy solutions that target the unique needs of commercially and publicly insured children. This cross-sectional study of commercially and publicly insured children in the US evaluates health coverage gaps, adequacy, and affordability comparing the periods before and during the COVID-19 public health emergency.
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