Uninsurance and health care access among young adults in the United States
Uninsurance and health care access among young adults in the United States
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DOI：
10.1542/peds.2004-1449
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发表时间：
2005-07-01
期刊：
影响因子：
8
通讯作者：
Cooper, WO
中科院分区：
文献类型：
--
作者：
Callahan, ST;Cooper, WO
目标。在美国，19岁至24岁的年轻人是最有可能没有保险的年龄段，但人们对没有保险可能如何影响年轻人的医疗保健服务知之甚少。本研究的目的是描述年轻人的医疗保险状况和医疗服务可获得性之间的关系，同时控制其他可获得医疗服务的决定因素。我们对1998年至2001年间完成全国健康访谈调查的11866名19岁至24岁的受访者的数据进行了横断面分析。我们给出了年轻人的百分比和调整后的相对风险，这些年轻人在前一年因费用原因延误或错过了医疗保健，因费用原因没有开处方，没有与卫生专业人员交谈，或者没有确定通常的卫生保健来源。在被研究的年轻人中，27%的女性和33%的男性没有保险。在调整了潜在的混杂因素后，未参保者报告延迟或错过医疗护理的风险仍然显著更高(女性：调整后的相对风险[95%可信区间]：3.24[2.72-3.82]；男性：4.31[3.44-5.34])，因为费用而没有开处方(女性：3.27[2.55-4.16]；男性：4.05[2.78-5.81])，没有与卫生专业人员接触(女性：2.54[2.01-3.09]；男性：1.60[1.43-1.77])，与私人参保的同龄人相比，没有正常的医疗保健来源(女性：3.45[3.05-3.90]；男性：2.27[2.06-2.48])。接受医疗补助的女性在这些指标上与私人参保的女性没有显著差异。没有保险的年轻人比私人保险的同龄人更有可能报告获得所需护理的障碍，没有与卫生专业人员接触，也没有确定通常的卫生保健来源。鉴于年轻人的失保率很高，需要进行额外的研究，以检查这些障碍如何影响年轻人的当前和未来健康。
Objective. Young adults who are 19 to 24 years of age are the most likely age group to be uninsured in the United States, yet little is known about how uninsurance might affect health care access among young adults. The objective of this study was to describe the association between health insurance status and health care access among young adults while controlling for other determinants of access to care.Methods. We conducted a cross-sectional analysis of data from 11866 19- to 24-year-old respondents who completed the National Health Interview Survey between 1998 and 2001. We present percentages and adjusted relative risk of young adults who in the previous year delayed or missed medical care because of cost, did not fill a prescription because of cost, had not spoken to a health professional, or identified no usual source of health care.Results. Among the young adults studied, 27% of women and 33% of men were uninsured. After potential confounders were adjusted for, the uninsured remained at significantly higher risk for reporting delayed or missed medical care ( women: adjusted relative risk [95% confidence interval]: 3.24 [2.72-3.82]; men: 4.31 [3.44-5.34]), not filling a prescription because of cost (women: 3.27 [2.55-4.16]; men: 4.05 [2.78-5.81]), having no contact with a health professional (women:2.54 [2.01-3.09]; men: 1.60 [1.43-1.77]), and having no usual source of health care (women: 3.45 [3.05-3.90]; men: 2.27 [2.06-2.48]) relative to privately insured peers. Women with Medicaid did not differ significantly from privately insured women in these measures.Conclusions. Uninsured young adults were significantly more likely than privately insured peers to report barriers to obtaining needed care, having no contact with a health professional, and identifying no usual source of health care. Given the high rates of uninsurance among young adults, additional study is needed to examine how these barriers affect the immediate and future health of the young adult.