Access to care is the centerpiece in the elimination of socioeconomic disparities in health
Access to care is the centerpiece in the elimination of socioeconomic disparities in health
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DOI：
10.7326/0003-4819-129-5-199809010-00012
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发表时间：
1998-09-01
影响因子：
39.2
通讯作者：
Andrulis, DP
中科院分区：
文献类型：
--
作者：
Andrulis, DP
许多卫生保健专业人员坚持一种几乎是一根筋的信念，即社会经济群体之间在获得卫生保健方面的差距是富人和穷人之间健康状况存在重大差异的关键原因。然而，其他人则认为，许多因素造成了重大障碍，减少或消除医疗保健的财政障碍对减少健康状况的差异几乎没有帮助。本文在承认各种促成因素的同时，认为消除基于财政的获取差异是任何努力创造社会经济群体成果公平的核心。通过有选择地审查关于健康保险、获得、结果和社会经济地位的许多研究，它确定了一个核心联系，即受影响的人口、他们在保健筹资方面的困难以及对他们福祉的威胁。在这样做的时候，它引用了一些调查结果，这些调查结果将缺乏保险（特别是生活在贫困中的人）、无法获得服务和不利的健康结果紧密联系在一起。它还使用了医疗补助和其他覆盖艾滋病毒感染者的例子，特别是作为一个重要的积极例子，其中平衡社会经济群体之间的医疗保健差异可以朝着创造质量和成果的方向发展。在今天的医疗保健环境的竞争压力有可能推动社会经济群体进一步分离，特别是投保和未投保的人。然而，最近颁布的国家行动，特别是国家儿童健康保险方案，是扩大健康保险的有力例子，可为各级决策者监测和减少社会经济差距提供经验教训。
Many health care professionals have sustained an almost single-minded conviction that disparities in access to health care across socioeconomic groups are the key reason for the major discrepancies in health status between wealthy persons and poor persons. Others, however, have argued that a host of factors work to create major impediments and that reducing or eliminating financial barriers to health care in particular will do little to reduce discrepancies in health status. This paper, while acknowledging the spectrum of contributing factors, argues that the elimination of financially based differences in access is central to any effort to create equity in outcomes across socioeconomic groups. Through selected review of the many studies on health insurance, access, outcomes, and socioeconomic status, it establishes that a core links affected populations, their difficulty in financing health care, and the threat to their well-being. In so doing, it cites findings that strongly associate lack of insurance (especially for persons who live in poverty), inability to obtain services, and adverse health outcomes. It also uses the example of Medicaid and other coverage for HIV-infected persons in particular as an important positive instance in which leveling the discrepancies in health care across socioeconomic groups can move toward creating quality in access and outcomes. The competitive pressures in today's health care environment threaten to drive socioeconomic groups further apart, especially insured and uninsured persons. However, the recent enactment of state actions, especially the State Child Health Insurance Program, represent powerful examples of health insurance expansion that have lessons for policymakers at all levels for the monitoring and reduction of socioeconomic disparities.