The health and healthcare impact of providing insurance coverage to uninsured children: A prospective observational study
The health and healthcare impact of providing insurance coverage to uninsured children: A prospective observational study
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DOI：
10.1186/s12889-017-4363-z
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发表时间：
2017-05-23
影响因子：
4.5
通讯作者：
Massey, Kenneth
中科院分区：
文献类型：
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作者：
Flores, Glenn;Lin, Hua;Massey, Kenneth
在美国480万没有保险的儿童中，62-72%有资格但没有参加医疗补助或CHIP。没有足够的是已知的，但是，对健康保险的影响的结果和成本为以前未投保的儿童，这从来没有被检查prospectively.Methods：这一前瞻性的观察性研究未投保的医疗补助/芯片合格的少数民族儿童比较儿童获得保险与那些剩余的未投保。受试者在97个社区站点招募，每月监测11个结果，持续1年。（P < .05）比未投保者更不可能有次优健康（27% vs. 46%）;无五氯苯酚（7%与40%）;从未/有时得到PCP的立即护理（7%对40%）;没有常规的预防性（1%对20%）或疾病（3%对12%）护理来源;未满足的医疗（13%对48%）、预防性（6%对50%）和牙科（18%对62%）护理需求。没有保险的人有更高的自付医生就诊费用（平均= 70美元对29美元），父母不向朋友推荐孩子的医疗保健提供者的比例（24%对8%）和报告孩子的健康状况导致家庭财务问题（29%对5%），以及较低的儿童护理访问质量评级。在双变量分析中，年龄较大，在美国以外出生，以及在基线时缺乏健康保险超过6个月与全年没有保险有关。在多变量分析中，基线时未投保超过6个月的儿童（比值比[OR]，3.8; 95%置信区间[CI]，1.4-10.3）和非洲裔美国儿童（OR，2.8; 95% CI，1.1-7.3）全年未投保的几率显著更高。保险节省了2886美元/投保儿童/年，平均医疗费用= 5155美元/未投保与2269美元/投保儿童（P = .04）。结论：提供医疗保险，医疗补助/芯片合格的未投保儿童改善健康，医疗保健的可及性和质量，以及家长的满意度;减少未满足的需求和自付费用;并节省2886美元/投保儿童/年。非裔美国儿童和那些没有保险超过6个月的儿童仍然没有保险的风险最大。通过为没有保险的、符合医疗补助/芯片资格的儿童提供保险而实现的储蓄外推表明，美国每年可以通过为所有符合医疗补助/芯片资格的没有保险的儿童提供医疗保险而节省87亿至101亿美元。
Background: Of the 4.8 million uninsured children in America, 62-72% are eligible for but not enrolled in Medicaid or CHIP. Not enough is known, however, about the impact of health insurance on outcomes and costs for previously uninsured children, which has never been examined prospectively.Methods: This prospective observational study of uninsured Medicaid/CHIP-eligible minority children compared children obtaining coverage vs. those remaining uninsured. Subjects were recruited at 97 community sites, and 11 outcomes monitored monthly for 1 year.Results: In this sample of 237 children, those obtaining coverage were significantly (P < .05) less likely than the uninsured to have suboptimal health (27% vs. 46%); no PCP (7% vs. 40%); experienced never/sometimes getting immediate care from the PCP (7% vs. 40%); no usual source of preventive (1% vs. 20%) or sick (3% vs. 12%) care; and unmet medical (13% vs. 48%), preventive (6% vs. 50%), and dental (18% vs. 62%) care needs. The uninsured had higher out-of-pocket doctor-visit costs (mean = $70 vs. $29), and proportions of parents not recommending the child's healthcare provider to friends (24% vs. 8%) and reporting the child's health caused family financial problems (29% vs. 5%), and lower well-child-care-visit quality ratings. In bivariate analyses, older age, birth outside of the US, and lacking health insurance for >6 months at baseline were associated with remaining uninsured for the entire year. In multivariable analysis, children who had been uninsured for >6 months at baseline (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.4-10.3) and African-American children (OR, 2.8; 95% CI, 1.1-7.3) had significantly higher odds of remaining uninsured for the entire year. Insurance saved $2886/insured child/year, with mean healthcare costs = $5155/uninsured vs. $2269/insured child (P = .04).Conclusions: Providing health insurance to Medicaid/CHIP-eligible uninsured children improves health, healthcare access and quality, and parental satisfaction; reduces unmet needs and out-of-pocket costs; and saves $2886/insured child/year. African-American children and those who have been uninsured for >6 months are at greatest risk for remaining uninsured. Extrapolation of the savings realized by insuring uninsured, Medicaid/CHIP-eligible children suggests that America potentially could save $8.7-$10.1 billion annually by providing health insurance to all Medicaid/CHIP-eligible uninsured children.